Foramen of Morgagni Hernia

Presentation

A 22-year-old obese man with no significant medical problems presents to his primary care physician with right upper quadrant abdominal pain for the past 2 weeks. The patient has no complaints of nausea or vomiting but has a history of constipation for several years. Examination of the abdomen reveals mild tenderness over the medial right costal arch.

▪ Chest X-rays

Figure 36-1

Figure 36-2

Chest X-ray Report

Posteroanterior and lateral chest x-rays demonstrate an abnormally large silhouette at the right cardiophrenic angle. This finding is consistent with a density behind the sternum as seen on the lateral x-ray. ▪

Discussion

The differential diagnosis for the x-rays shown includes a pericardial cyst, lipoma of the epicardial fat, and diaphragmatic herniation. Computed tomography (CT) scans will aid in further diagnosis and planning treatment. Oral contrast should be administered to patients in whom the diagnosis of diaphragmatic hernia is highly suspicious.

▪ CT Scans