Learning Radiology xray montage
 
 
 
 
 
 

Morgagni and Bochdalek Hernia

 

Morgagni Hernia

  • Anterior – Morgagni
    • Anteromedial parasternal defect (Space of Larrey)
    • Maldevelopment of septum transversum
    • Tends to occur in overweight, middle-aged, women
    • Right > left (heart protects)
    • Usually not large
    • Usually unilateral
    • Associated with
      • Pericardial defects
      • Omental fat in pericardial space

Bochdalek Hernia

  • More common
    • Occurs through old pleuroperitoneal canals
      • Just lateral to the spine on either side
  • More frequent on left side
    • Possibly due to “protection” of right-side by liver
    • Hernia may contain intestine, stomach, spleen, liver or omentum
  • If hernia occurs on right
    • Intestine and liver or only liver may herniate
  • If the defect is large, newborns usually present with
    • Severe respiratory distress
    • Cyanosis
    • Scaphoid abdomen
  • Entire diaphragm is almost never absent
    • Some part of diaphragm is usually found at surgery, even if defect is very large
  • Hypoplasia of ipsilateral lung occurs from mass effect of bowel
  • Most often these are isolated congenital abnormalities
    • But they can have
      • Congenital Heart Disease
      • 13 ribs
      • Malrotation of GI tract frequently present
        • Possibly due to “protection” of right-side by liver
        • Hernia may contain intestine, stomach, spleen, liver or omentum
      • If hernia occurs on right
        • Intestine and liver or only liver may herniate
      • If the defect is large, newborns usually present with
        • Severe respiratory distress
        • Cyanosis
        • Scaphoid abdomen
      • Entire diaphragm is almost never absent
        • Some part of diaphragm is usually found at surgery, even if defect is very large
      • Hypoplasia of ipsilateral lung occurs from mass effect of bowel
      • Most often these are isolated congenital abnormalities
        • But they can have
          • Congenital Heart Disease
          • 13 ribs
          • Malrotation of GI tract frequently present
             

Bochdalek Hernia

 
Bochdalek Hernia. Frontal view of the chest shows a large air-containing and walled structure in the region of the left lower lobe (white arrow). It is originating from below the diaphragm. The air-containing structure is seen posteriorly on the lateral view (red arrow).