Differential Diagnosis
- Cardiophrenic fat pad
- Diaphragmatic rupture
- Focal diaphragmatic eventration
- Foramen of Morgagni hernia
Diagnosis
The right cardiophrenic angle reveals 12 x 9 x 10 cm bowel containing soft tissue mass, with a diagnosis of foramen of Morgagni diaphragmatic hernia. Symptoms include abdominal pain and respiratory symptoms which may be associated with a strangulated hernia. The chest radiographic findings include a smoothly marginated soft tissue mass in the lower anterior medial thorax, in the region of the cardiophrenic angle. The mass is contiguous to the hemidiaphragm. Gas-containing bowel may be visible within the mass density. Diagnosis is usually confirmed on CT and upper GI series studies.
Learnings/What to Look for
- Foramen of Morgagni is a triangular-shaped defect in the diaphragm between the sternal and costal attachments of the anterior medial It is a normal anatomic landmark through which the internal mammary vessels pass
- Usual contents of the hernia are omentum and colon, but small bowel, stomach and duodenum also may herniate
- Hernia sac is usually located in the lower medial anterior chest adjoining the heart and is contiguous with the anterior hemidiaphragm
- They are most often seen on the right side
Pearls for Urgent Care Management and Consideration for Transfer
- Supportive treatment for symptom relief may be managed by a gastroenterologist
- Treatment is surgical, usually via a laparoscopic procedure, though some require a thoracoscopic approach
Acknowledgement: Images and case provided by Teleradiology Specialists, www.teleradiologyspecialists.com.