IS Case 606: Morgagni hernia with liver herniating into the chest
Imaging Sciences URMC 2010
Publication Date: 2011-11-17
History
The patient is a 13-month-old female with a 1-week history of fever and upper respiratory symptoms and lethargy for which she was being treated as an outpatient with amoxicillin. The patient was referred to our hospital by her pediatrician when an outside chest radiograph revealed a large focal mass in the right chest concerning for malignancy.
Findings
Chest radiograph revealed a large focal mass in the right chest silhouetting the right cardiac border and medial right hemidiaphragm. CT chest without contrast with coronal reconstructions demonstrated herniation of the liver into the right chest through a Morgagni hernia.
Diagnosis
Morgagni hernia with liver herniating into the chest
Discussion
“Congenital diaphragmatic hernias are usually secondary to posterior defects in the diaphragm (Bockdalek hernia) and are more common on the left side by a ratio of 5 to 1.” [1] Morgagni hernias are a less common form of congenital diaphragmatic hernia (CDH), occurring in only 5-10% of cases. This hernia occurs in the anterior midline through the sternocostal hiatus of the diaphragm, with 90% of cases occurring on the right side. The hernia may contain stomach, small bowel, colon, or liver. Hernias through the foramen of Morgagni are more likely to contain solid abdominal viscera and are usually less severe clinically.
The radiographic appearance ranges from a soft tissue mass, to an air containing cystic mass in the chest with displaced bowel loops in the abdomen, pulmonary hypoplasia, and potential mass effect on the mediastinum. Alternative diagnoses to consider in the newborn with respiratory distress and a mass-like lesion on radiographs include congenital cystic adenomatoid malformation (CCAM) , bronchogenic cyst, and sequestration.
Clinically patients with CDH and pulmonary hypoplasia present with marked hypoxia at birth. Treatment options involve supportive care on ECMO or a high frequency ventilator as a bridge towards corrective surgery. Most patients with CDH have associated malrotation due to displace bowel loops. “CDH may be minimally symptomatic at birth and can present later in life” [2].
References
- Donnelly LF. Pediatric Imaging: The Fundamentals. Saunders, 208:37-38.
- Brant WE, Helms CA. Fundamentals of Diagnostic Radiology. Third Edition. Lippincott Williams & Wilkins, 2006:1240-1241
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