Left Morgagni hernia: atypical presentation

Case contributed by Dr Maxime St-Amant

Presentation

Chest pain.

Patient Data

Age: 35
Gender: Male

There is a left paracardiac relatively radiolucent opacity mimicking cardiomegaly. The actual cardiac silhouette is normal, when looking carefully. Lung parenchyma is normal. This opacity is possibly caused by fat, since it is relatively radiolucent.

CT-scan confirms a left Morgagni hernia containing greater omentum fat. 

Case Discussion

Morgagni hernias are more frequently encountered on the right side. The diaphragmatic defect and epiploic vessels confirm this diagnosis instead of a fat pad. They are a lot rarer than Bochdaleck (posterior) hernia. This case is particularly interesting since the fat density on plain film mimics a cardiomegaly.

Extensive pericardial lipomatosis, lipoma or extensive pericardial fat pad (e.g. in a patient with Cushing's syndrome) are the most important differential diagnosis in this case.

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