Morgagni hernia

Morgagni hernias (alternative plural: herniae) are one of the congenital diaphragmatic hernias (CDHs), and are characterized by herniation through the foramen of Morgagni. When compared to Bochdalek hernias, Morgagni hernias tend to be:

• anterior
• more often right-sided (~90%)
• small
• rare (~2% of CDH)
• at low risk of prolapse

Clinical presentation

Only ~30% of patients are symptomatic. Newborns may present with respiratory distress at birth similar to a Bochdalek hernia. Additionally, recurrent chest infections and gastrointestinal symptoms have been reported in those with previously undiagnosed Morgagni hernia.

Epidemiology

Associations

• pentalogy of Cantrell
• congenital heart disease
• trisomy 21 (Down syndrome)
• intestinal malrotation ⁷

Pathology

Morgagni hernias most often contain omental fat, but transverse colon (60%) or stomach (12%) may be included within the hernia. 

Treatment and prognosis

Some sources recommend laparoscopic surgical repair, even in asymptomatic patients, to avoid the risk of strangulation of the hernia contents ⁶.

Differential diagnosis

• cardiophrenic angle lesions: the main differential diagnosis for Morgagni hernia is a cardiophrenic fat pad. It appears radiolucent compared with other lesions not containing fat 
• focal diaphragmatic eventration 
• diaphragmatic rupture: from trauma, but usually other supportive signs of chest and/or abdominal trauma would be apparent. This is most commonly seen posterior and posterolaterally 

See also

• Bochdalek hernia
• abdominal hernias