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Sudden Respiratory Failure after a Coughing Paroxysm
André Rosa Alexandre1, Sérgio Santos Pinto2
1Internal Medicine and Intensive Care Department, Hospital Da Luz, Lisboa, PRT.
Cureus
|January 1, 2020
Summary
This case study highlights a rare instance of a Morgagni hernia in an elderly female presenting with respiratory distress. Conservative management was successful, suggesting it as a viable alternative for select patients with this diaphragmatic hernia.
Area of Science:
- Gastroenterology
- Thoracic Surgery
- Emergency Medicine
Background:
- Spontaneous diaphragmatic hernias are rare and typically require surgical intervention.
- Morgagni hernias, specifically, involve abdominal organs protruding through the diaphragm into the chest.
Observation:
- An 85-year-old female presented with sudden dyspnea and hypoxemic respiratory failure after a coughing episode.
- Physical examination revealed diminished breath sounds and bowel sounds in the right hemithorax.
- Imaging confirmed a large anterior right paracardiac transdiaphragmatic hernia of small bowel (Morgagni hernia) with secondary pulmonary atelectasis.
Findings:
- Thoracic computed tomography definitively diagnosed a giant Morgagni hernia.
- A coexisting posterior left transhiatal gastric hernia was also identified.
- The patient experienced hypoxemic respiratory failure secondary to passive pulmonary atelectasis.
Implications:
- This case demonstrates that conservative management, including nasogastric intubation, can be effective for selected patients with Morgagni hernias.
- It challenges the traditional surgical-only approach for this rare condition.
- Highlights the importance of considering diaphragmatic hernias in elderly patients with unexplained respiratory symptoms.
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