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.

An 86-Year-Old Man with a Short History of Cough and Stomach Pain
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