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Morgagni hernia: an unexpected cause of respiratory complaints and a chest mass
H Soylu1, U Koltuksuz, N O Kutlu
1Department of Pediatrics, Inönü University, Turgut Ozal Medical Center, Malatya, Turkey. hasoylu@hotmail.com
Insights
Morgagni hernia (MH), a rare congenital diaphragmatic hernia, often presents with respiratory symptoms like cough in children. Early diagnosis via imaging and surgical repair are key to successful outcomes.
Area of Science:
- Pediatric Surgery
- Radiology
- Congenital Anomalies
Background:
- Morgagni hernia (MH) is the rarest form of congenital diaphragmatic hernias.
- While often asymptomatic, MH can manifest with respiratory and gastrointestinal symptoms.
Purpose of the Study:
- To describe the clinical presentation, diagnosis, and management of Morgagni hernia in children.
- To highlight the importance of considering MH in pediatric respiratory cases.
Main Methods:
- Retrospective case series of 7 children diagnosed with MH over 5 years across three Turkish pediatric centers.
- Diagnosis utilized posterior-anterior (PA) and lateral chest X-rays, confirmed with barium-contrast radiography.
Main Results:
- All 7 pediatric patients presented with acute or chronic respiratory symptoms, most commonly cough.
- Radiological findings included masses or cystic images in the cardiophrenic angle and gas-filled bowel loops above the diaphragm.
- Four patients had associated anomalies, including cardiac, inguinal, orthopedic, and urological conditions.
Conclusions:
- Morgagni hernia should be considered in the differential diagnosis of persistent respiratory symptoms in children.
- Unexplained radiological findings, particularly in the right cardiophrenic area, warrant investigation for MH.
- Surgical repair via an abdominal approach was effective with no complications or recurrences.
Abstract:
Morgagni hernia (MH) is the least common type of congenital diaphragmatic hernias. Although its course is often asymptomatic, it may be associated with various respiratory and gastrointestinal symptoms. We describe 7 children with MH during a 5-year period in three pediatric centers in Turkey. All children had acute or chronic respiratory symptoms; cough was the most frequent. The diagnosis was made by posterior-anterior (PA) and lateral chest X-rays. The PA chest X-rays showed a homogenous mass in 2 and a gas-filled cystic image in 3 children in the right cardiophrenic angle. A retrocardiac homogeneous density in one child, and bilateral consolidation in lower lung areas in another child were also seen. All lateral chest X-rays showed gas-filled bowel loops above the diaphragm. The diagnosis was confirmed by barium-contrast radiograph. Four patients had five additional anomalies, i.e., ventricular septal defect, right inguinal hernia, congenital hip dislocation, pectus carinatum, and obstruction of the uretero-pelvic junction. All of the hernias were repaired by an abdominal approach. There were no complications or recurrences during follow-up. In conclusion, MH should be considered in the differential diagnosis of cases of long-standing respiratory symptoms and/or when an unexplained radiological image, especially on the right cardiophrenic area, is present.