A huge Morgagni hernia with compression of the right ventricle

Abstract

A 21 year old male with no relevant medical history presented to our Institution for further assessments of a right paracardiac mass founded on a chest X-ray. Chest computed tomography revealed a wide median defect of the diaphragm at the level of xiphoid process of the sternum, with the herniation of omental fat tissue in the mediastinum. Cardiac magnetic resonance confirmed the presence of a huge hernia originating from the foramen of Morgagni (sterno-costal hiatus), displacing the heart leftwards and posteriorly and compressing the right ventricle (RV), giving to it a tubular shape.The signal characteristics were typical of fat tissue, with hyperintense signal in T1 and T2 weighted black blood images and homogeneus signal suppression on STIR T2 black blood images. Short axis real time cine images, performed during deep inspiration, showed an early diastolic ventricular septal bounce, with flattening of the interventricular septum during mid-late diastole: they represented signs of diastolic dysfunction of the right ventricle, resembling a sort of "pseudo-constrictive" pathophysiological model. The patient was thus referred to surgical repair of the diaphragmatic defect.

Intestinal Tamponade

“…It is well established that posterior hiatal hernias cause left atrial compression and result in hemodynamic instability [1,4]. There are reported instances of a Morgagni hernia causing cardiovascular compromise, though only 1 with objective evidence using cardiac magnetic resonance imaging to demonstrate compression of the right ventricle [2][3][4][5]. In retrospect, a right heart catheterization in this case would have been illustrative though arguably unnecessarily invasive.…”

“…Similarly, patients with paraesophageal hernia can have a spectrum of clinical presentations ranging from an incidental discovery to life-threatening gastric ischemia. These 2 types of hernias have each independently been shown to cause cardiac compression and impair diastolic function [1][2][3][4][5]. We present the first case of simultaneously occurring Morgagni and paraesophageal hernias with an atypical presentation of paroxysmal cough-induced syncope.…”

Acute Respiratory Failure, Ischemic Modifications on Electrocardiogram: Alternative Etiology—A Case of Morgagni Hernia

“…The ECG-specific abnormality in healthy women with T-wave inversion in precordial leads is very suspicious of ischemia, but there are very few cases in the medical literature of these modifications being related to a Morgagni hernia [10,12]. Zanini's medical team proposed that ECG modifications can be associated with hiatal hernia [13].…”

Larrey diaphragmatic hernia in an adult

“…It usually symptomatically manifests later in life. In addition to the leftsided one, there is also a hernia called Morgagni right-sided anterior congenital hernia, which occurs more frequently, in 90% of the cases, and a hernia called Morgagni-Larrey hernia, which is bilateral, and the incidence of which is around 8% (Figure 1) [1,2,3].…”