SPR Unknown # 93 -- FINAL

Jennifer C Talmadge, MD

Maine Medical Center, Portland, Maine

PGY-5

Charles K Grimes, MD

Maine Medical Center, Portland, Maine

Section Co-Chief, Pediatric Radiology


Publication Date: 2013-08-08

History

The patient is a 7 year old asymptomatic female with a past medical history of constipation. A radiograph performed at an outside hospital to work up possible scoliosis revealed a thoracic mass. The patient was referred to our institution for a PA and lateral chest xray. Following consultation with a thoracic surgeon, a chest CT was obtained. The second set of radiographs were taken three months after the first radiographs, following surgical intervention.

Findings

The initial PA chest radiograph demonstrates silhouetting of the right heart border which has an abnormal convexity. On the lateral veiw there is a triangular shaped mass in the anterior inferior chest which contains both soft tissue and gas density. Chest CT confirms the radiographic findings and demonstrates herniation of a segment of colon and liver into the chest. The hernia was repaired by a thoracic surgeon, and follow up radiographs demonstrate resolution of the hernia.

Diagnosis

Morgagni hernia

Discussion

A Morgagni hernia consists of a defect in the anterolateral diaphragm and represents a minority of congenital diagphragmatic hernias (2-5%). These are usually small and contain omentum. Morgagni hernias can also contain colon, liver, and small bowel. 90% occur on the right side. Many Morgagni hernias are found incidentally, and some are not diagnosed until adulthood. Others present secondary to bowel strangulation, obstruction, respiratory distress, or recurrent pneumonia. The hernia is often isolated, although there are reported associations between Morgagni hernias and other anomalies, including congenital heart defects, malrotation, and trisomy 21. The differential considerations for the radiographic appearance includes a pericardial fat pad, thoracic mass such as CPAM or pericardial cyst, or a pulmonary parenchymal abnormality such pneumonia. Surgical repair is often performed, particularly if the hernia contains bowel or is symptomatic.

Files

References

  1. Al-Salem, AH. "Congenital hernia of Morgagni in infants and children." J Pediatr Surg, 42, Sept 2007: p1539-1543.
  2. Laituri CA, Garey CL, Ostlie JD, Holcomb GW 3rd, St Peter SD. "Morgagni hernia repair in children: comparison of laparoscopic and open results." J Laparoendosc Adv Surg Tech A. Jen-Feb 2011, 21(1):89-91.
  3. Panicek DM et al. "The diaphragm: anatomic, pathologic, and radiologic considerations." Radiographics. 8(3): 385-425, 1998.

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