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The Morgagni hernia, in which the defect is found in an anterior and retrosternal location, was first described by Morgagni in 1769. It is rarer than the other type of congenital diaphragmatic hernia (Bochdalek hernia) and comprises only 2% to 5% of all congenital diaphragmatic hernias. Morgagni hernias tend to be less symptomatic as pulmonary hypoplasia is uncommon, leading to a delayed diagnosis of these defects. . Abdominal organs herniate to the thorax through a retrosternal diaphragmatic defect from the right side in 90% of the cases. Pericardium has been considered to be responsible for the decreased incidence of left-sided Morgagni hernia. Bilateral cases have been reported uncommonly. Increased intraabdominal pressure have been associated with Morgagni hernia, especially in the adult age group. Chest x-ray and thorax computed tomography (CT) are helpful in diagnosis. Omentum, transvers colon and less often stomach and small bowel are herniating organs to thorax. Treatment is surgery which can be performed with transthoracic, transabdominal, laparoscopic or thoracoscopic approaches.
A 65-year-old female known case of a long stand of hypertension, and adult protistic kidney disease, resulting in end-stage kidney disease with renal replacement therapy in the form of haemodialysis. The patient has a history of multiple emergency room visits with shortness of breath. As part of the investigation of her shortness of breath, an Xray was done which revealed well-demarcated opacity involving the right mid and lower zone of the chest with the lob of the transverse colon seen above the right diaphragmatic cupula, CT chest was done which confirmed the presence of right diaphragmatic omental fat and large bowels containing hernia. the diaphragmatic defect is seen in the right cardio phrenic angel measuring 9.2 cm. Diagnosis of Morgagni hernia by thoracic surgeon, right nephrectomy, and repair of Morgagni hernia through subcostal incision. It heeled with no recurrent as evidenced by a recent CT scan.
this Chest Xray was done after hernia repair doesnt demonestrate the colon with air in the lumen as in previous imaes.
In a new dialysis patient careful exploration of other causes of shortness of breath is essential as not all causes are related to volume overload.