A Rare Cause of Shortness of Breath

Abstract

A 66-year-old woman complained about solid-food dysphagia, postprandial midchest tightness, and exertional shortness of breath on exertion. Her physical examination and laboratory test results were unremarkable. A cardiac stress test was normal. An echocardiogram was attempted but no good echo window was found. Computed tomography of the chest showed a large Morgagni hernia and a paraesophageal hernia (Figures A, B, and C). The combination of Morgagni and paraesophageal hernias is rare in nontraumatic hernia conditions. Only 5 cases have been reported in the English literature. A Morgagni hernia is a herniation of the abdominal contents into the thorax through a retrosternal diaphragm defect resulting from a congenital abnormality, blunt trauma, penetrating injuries, or an iatrogenic cause. Most Morgagni hernias have occurred in obese women and on the right side (90%).The hernia sac commonly contains omentum but sometimes colon, small bowel, and other organs. Although most individuals are asymptomatic, respiratory distress, obstruction, incarceration, strangulation, or perforation may occur. Computed tomography is the best diagnostic tool for a Morgagni hernia. On the other hand, paraesophageal hernia is an uncommon hiatal hernia that may cause abdominal pain, belching, and gastric volvulus. All symptomatic combined hernia patients should be treated surgically, although the best surgery strategy is unclear because of its rarity. Our patient is scheduled to have combined laparoscopic hernia repair.