Hernia de Morgagni en la edad adulta

Introducción: La hernia de Morgagni es una anomalía congénita rara, responsable del 3% de las hernias diafragmáticas, que provoca opacidades radiológicas paracardíaca y retroesternal que suelen confundirse con otras afecciones. Objetivo: Notificar el caso de un paciente adulto diagnosticado con hernia de Morgagni en el Hospital General Docente "Dr. Antonio Luaces Iraola" de Ciego de Ávila. Caso clínico: Se presenta el caso de un varón de 28 años de edad con antecedentes de contusión torácica severa, que presentó dolor abdominal, dispepsias, dolor recurrente en región baja posterior del hemitórax derecho, falta de aire ligera y tos seca. Con la aplicación de un correcto método clínico se excluyeron otros posibles diagnósticos planteados previamente y se concluyó con estudios imagenológicos como una hernia de Morgagni. Se realizó tratamiento quirúrgico mediante laparotomía convencional. La evolución fue favorable, sin complicaciones posoperatorias y con egreso hospitalario precoz. Conclusiones: Se notificó el caso de un paciente diagnosticado con hernia de Morgagni que constituyó un tipo raro de hernia en adultos, cuyo diagnóstico se debe tener en cuenta en pacientes con manifestaciones clínicas digestivas o respiratorias, que presentan radiopacidad paracardíaca en la radiografía de tórax. Es necesario realizar tratamiento quirúrgico oportuno para prevenir posibles complicaciones.

Introduction: Morgagni's hernia is a rare congenital anomaly, responsible for 3% of diaphragmatic hernias, which causes paracardiac and retrosternal radiological opacities that are often confused with other conditions. Objective: To report the case of an adult patient diagnosed with Morgagni's hernia at "Dr. Antonio Luaces Iraola" General Teaching Hospital from Ciego de Avila. Clinical casereport: We report the case of a 28-year-old man with history of severe chest contusion, who showed abdominal pain, dyspepsia, recurrent pain in the lower posterior region of the right hemithorax, slight shortness of breath, and dry cough. With the use of the correct clinical method, other possible diagnoses were excluded from what was previously raised. Imaging studies concluded to be a Morgagni hernia. Surgical treatment was performed by conventional laparotomy. The evolution was favorable, without postoperative complications and with early hospital discharge. Conclusions: The case of a patient diagnosed with Morgagni's hernia was reported. It constituted a rare type of hernia in adults. Its diagnosis should be taken into account in patients with digestive or respiratory clinical manifestations, showing paracardiac radiopacity on chest X-ray. Timely surgical treatment is necessary to prevent possible complications.

Posterior Diaphragmatic Defect Detected on Chest CT: the Incidence according to Age and the Lateral Chest Radiographic Appearances

PURPOSE: We wanted to investigate the incidence of posterior diaphragmatic defect on chest CT in various age gropus and its lateral chest radiographic appearances. MATERIALS AND METHODS: The chest CT scans of 78 patients of various ages with posterior diaphragmatic defect were selected among 1,991 patients, and they were analyzed for the incidence of defect in various age groups, the defect location and the herniated contents. Their lateral chest radiographs were analyzed for the shape of the posterior diaphragm and the posterior costophrenic sulcus. RESULTS: The patients' ages ranged from 34 to 87 with the tendency of a higher incidence in the older patients. The defect most frequently involved the medial two thirds (n= 49, 50.4%) and middle one third (n=36, 37%) of the posterior diaphragm. The retroperitoneal fat was herniated into the thorax through the defect in all patients, and sometimes with the kidney (n=8). Lateral chest radiography showed a normal diaphragmatic contour (n=51, 49.5%), blunting of the posterior costophrenic sulcus (n=41, 39.8%), focal humping of the posterior diaphragm (n=7, 6.8%), or upward convexity (n=4, 3.9%) of the posterior costophrenic sulcus on the affected side. CONCLUSION: The posterior diaphragmatic defect discovered in asymptomatic patients who are without a history of peridiaphragmatic disease is most likely acquired, and this malady increases in incidence according to age. An abnormal contour of the posterior diaphragm or the costophrenic sulcus on a lateral chest radiograph may be a finding of posterior diaphragmatic defect.

Crura Sign: Differentiation between Traumatic Rupture of the Diaphragm and Nontraumatic Elevation on CT

PURPOSE: To evalvate whether in patients with diffuse evaluation of a hemidiaphragm on chest radiographs, the apparence of the crura on CT might be helpful in differentiating between traumatic rupture of the diaphragm(TRD) and nontraumatic causes such as diaphragmatic palsy or diffuse diaphragmatic eventration. MATERIALS AND METHODS: Among patients with diffuse elevations of a hemidiaphragm on chest radiograph, 27 who had patients undergone CT scans were retrospectively reviewed. Twelve patients had surgically proven TRD, and 15 had nontraumatic elevation of a hemidiaphragm such as diaphragmatic palsy or diffuse diaphragmatic eventration. Under the hypothesis that the affected crus is markedly thinner than the normal side in nontraumatic elevation but is normal in TRD ("crura sign"), we optically assessed without measurement the thickness of both crura. RESULTS: In all patients with TRD, the thickness of the affected crus was similar to that of the contralateral side. In all patients with nontraumatic causes, however, the crus of the elevated hemidiaphragm was markedly thinner than of the normal side. CONCLUSION: The "crura sign" may be useful additional CT finding of traumatic rupture the diaphragm.

CT Anatomy of the Diaphragm: Changes in End Inspiration and End Expiration

PURPOSE: To assess the change in configuration of the diaphragm between scans obtained at end inspiration and end expiration. MATERIALS AND METHODS: Two series of CT scans at end inspiration and at end expiration were obtained in 37 patients. We evaluated the changes in the type of anterior diaphragm, pseudotumor, undulation ofthe diaphragm, and diaphragmatic defect during the respiratory phases. RESULTS: The configuration of the anterior portion of the diaphragm changed between end inspiratory and end expiratory CT scans in 25(67.6%) of 37 patients. Diaphragmatic defect, diaphragmatic pseudotumor, and undulation of the diaphragm were more frequent at end inspiration (13.5%, 18.9%, 37.8%, respectively) than at end expiration (0%, 5.4%, 10.8%, respectively). CONCLUSION: There is a change in the configuration of the anterior portion of the diaphragm and we also observed differences in the visualization of diaphragmatic defects, pseudotumor, and undulation between scans obtained at end inspiration and end expiration.