Presentation
Chronic dry cough. No chest pain or shortness of breath. Background: Trisomy 21.
Patient Data
Hemidiaphragms are obscured by multiple lucencies projecting over both lower lungs suspicious for bowel loops.
Large anterior diaphragmatic hernia containing loops of bowel. Secondary displacement of the mediastinum and volume loss in the lung bases. No evidence of obstruction or strangulation.
Incidental note of aberrant right subclavian artery.
Incompletely visualized hypodense focus in the right lobe of the liver.
Case Discussion
Large anterior diaphragmatic hernias are divided into:
- Morgagni hernia: rare (2% of all diaphragmatic hernias) congenital herniation of abdominal contents into the thoracic cavity through the retrosternal foramina of Morgagni which lie within muscular part of the diaphragm. Morgagni hernias tend to be small, seen mainly in right hemithorax and generally diagnosed in children, however, in 5% of cases are found in adults.
- Other anterior hernias: herniation of abdominal contents into the thoracic cavity through defect in tendinous part of diaphragm
In this case, it is uncertain if the bilateral herniation of large and small bowel into the thoracic cavity is through the Morganini foramina or through a large defect in tendinous part of the diaphragm.
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