Morgagni hernia

Case contributed by Dr Mohamed Mahmoud Elthokapy

Presentation

Neonate presented with respiratory distress and recurrent chest infection.

Patient Data

Age: 25 days
Gender: Female
X-ray

Gas-filled viscus is seen bulging within the right hemithorax above the level of the diaphragm, extending superiorly to the level of the hilum, consistent with a loop of bowel through a Morgagni diaphragmatic hernia. Just laterally to the bulging viscus, there is a soft tissue shadow continuous with liver shadow, suggesting partial liver herniation.

Mild contralateral mediastinal shift to the left.

Barium

A contrast enema study was done with the administration of rectal contrast material and proper opacification of different colonic segments, revealing evidence of diaphragmatic hernial defect with herniated hepatic colonic flexure and part of the transverse and ascending colonic segments into the right anterior hemithorax with mild indentation laterally by the herniated hepatic dome.

Nasogastric tube and leads are incidentally seen.

CT

Evidence of large right anterior diaphragmatic hernial defect measuring about 4.5x3.5 cm passing colonic segments and part of the hepatic dome into right hemithorax with mass effect and contralateral mediastinal shift

Features of a Morgagni hernia.

Relatively prominent bilateral breast soft tissue, likely transmitted maternal hormonal changes.

Nasogastric tube is seen in situ.

Case Discussion

Considering the clinical scenario, imaging features are compatible with a classic Morgagni hernia containing bowel loops and hepatic portion.

A Morgagni hernia is a type of congenital diaphragmatic hernia through the foramen of Morgagni which is at the anteromedial aspect of the diaphragm usually on the right side.

Once the diagnosis of congenital Morgagni hernia is confirmed, it should be repaired surgically, regardless of whether symptomatic or asymptomatic

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