Morgagni-Hernie

Lipomatöse
Morgagni-Hernie: Röntgenübersicht mit glatt begrenzter Verschattung rechts parakardial. Die Computertomographie zeigt den Durchtritt von abdominell nach thorakal ventral median bis rechts paramedian. Bei der Menge von Fett ist von einer zusätzlichen Lipomatose / lipomatösen Hypertrophie auszugehen. Kein Darm herniert.
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School ager
with substernal distress associated with exercise. CXR AP and lateral (above) shows an anteromedial soft tissue density in the right cardiophrenic angle obscuring the right heart border. Sagittal US of the chest performed anteriorly and just to the right of the midline (below left) shows liver extending above the level of the diaphragm. Axial CT with contrast of the chest (below right) shows liver in the right cardiophrenic angle just to the right of the heart in the right hemithorax.The diagnosis was a right-sided Morgagni hernia containing liver.
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Sagittal CT
of the chest with intravenous contrast demonstrates a Morgagni hernia (red arrow) containing abdominal fat.
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Preschooler
with several days of epigastric pain when laying down. CXR PA shows the right heart border to be obscured and the lateral shows loops of bowel rising above the diaphragm anterior to the heart.The diagnosis was Morgagni hernia which in the operating room was found to contain the cecum and an acutely inflamed appendix, thus adding the diagnosis of acute appendicitis.
pediatricimaging.org • CC-by-nc-sa 4.0
Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. CT axial image shows prominent soft tissue with fat density obliterating the right cardio-phrenic angle and mildly displacing the lateral wall of the right atrium.
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Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. CT axial image shows prominent soft tissue with fat density obliterating the right cardio-phrenic angle.
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Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. CT axial image shows prominent soft tissue with fat density obliterating the right cardio-phrenic angle.
www.eurorad.org • CC by-nc-sa-4.0
Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. MIP sagittal image shows an opening in the anterior portion of the right hemidiaphragm and omental blood vessels that cross the diaphragmatic breach within the fat tissue.
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Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. Chest coronal image shows an opening in the anterior portion of the right hemidiaphragm with continuity between the mediastinal and the intra-abdominal fat.
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Morgagni
hernia containing omental fat: differential diagnosis with prominent epicardial fat pad. Chest lateral scout view shows retrosternal triangular opacity.
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Unusual
association of parvo-virus with Morgagni hernia, mistaken for patch of consolidation. Axial mediastinal (A) and lung (B) window showed a homogenous soft tissue density in RT cardio-phrenic angle abutting and displacing the pericardium and RT ventricle with clear interface. Sharp delineation with lung parenchyma is noted.
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Preschooler
post motor vehicle accident who was subsequently noted to have a history of epigastric pain while lying down. AP radiograph of the thoracic spine (left) shows a loop of bowel containing haustra in the lower chest just above the diaphragm. CXR lateral (right) shows a loop of bowel in the anterior chest.The diagnosis was Morgagni hernia.
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Radiopaedia • CC-by-nc-sa 3.0 • de

Morgagni hernias (alternative plural: herniae) are one of the congenital diaphragmatic hernias (CDHs), and are characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias tend to be:

  • anterior
  • more often right-sided (~90% - If left-sided it's sometimes called Larrey hernia; the term Morgagni-Larrey hernia sums up both sides left and right)
  • small
  • rare (~2% of CDH)
  • at low risk of prolapse

Clinical presentation

Only ~30% of patients are symptomatic. Newborns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.

Epidemiology

Associations

Pathology

Morgagni hernias most often contain omental fat, but transverse colon (60%) or stomach (12%) may be included within the hernia.

Treatment and prognosis

Some sources recommend laparoscopic surgical repair, even in asymptomatic patients, to avoid the risk of strangulation of the hernia contents .

Differential diagnosis

  • cardiophrenic angle lesions: the main differential diagnosis for Morgagni hernia is a cardiophrenic fat pad. It appears radiolucent compared with other lesions not containing fat 
  • focal diaphragmatic eventration 
  • diaphragmatic rupture: from trauma, but usually other supportive signs of chest and/or abdominal trauma would be apparent. This is most commonly seen posterior and posterolaterally 

See also

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Morgagni-Hernie:
Bauchwandhernien
 
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Zwerchfellhernie
 
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Morgagni-Larrey
hernia
Wikipedia • CC BY-SA 4.0
Bochdalek"sche
Hernie
Wikipedia • CC BY-SA 4.0