Presentation
Young lady presented with shortness of breath. No history of trauma or recent surgery.
Patient Data
Frontal chest radiograph in supine position demonstrates lobulated lucencies in the right mid and lower lung extending into the right upper quadrant with evidence of bowel haustration and adjacent peripheral dense opacity consistent with Morgagni hernia herniated omental fat and right colon.
Multiplanar CT chest with IV contrast and previously administrated oral contrast demonstrates a large size anterior diaphragmatic defect with herniation of omental fat and non-obstructed right colon and hepatic colonic flexure. The hernia has a mild mass effect on the right atrium with mild leftward mediastinal shift and adjacent right compressive atelectasis.
Case Discussion
Morgagni hernia is one type of diaphragmatic hernia that can be congenital or acquired after trauma. The differential diagnosis on the initial chest radiograph could include loculated hydropneumothorax. The best cheapest next step is to do a lateral decubitus radiograph to look for the interval dependent changes and air-fluid level. CT can confirm the diagnosis.