Antenatal diagnosis of a Morgagni hernia in the second trimester

Abstract

Morgagni hernia is an uncommon type of congenital hernia that is rarely diagnosed antenatally. Herniation of the liver into the fluid-filled pericardial sac resulting in a thoracic mass is a particularly rare form of Morgagni hernia; only 3 cases have been reported in the literature, all with a diagnosis made at 32 weeks' gestation or later. We report a case of Morgagni hernia diagnosed on antenatal sonography at 24 weeks' gestation.

Morgagni Hernia with Massive Pericardial Effusion Diagnosed in the Second Trimester: Prenatal Diagnosis and Perinatal Management

“…No fetal hydrops was observed in our case or in the past 6 cases [2,3] . Pulmonary compression and hypoplasia correlated with intrapericardial diaphragmatic hernia is a lower-frequency occurrence of respiratory problems compared to common posterior diaphragmatic hernia.…”

“…Herniation of the liver into the pericardial sac resulting in an intrathoracic mass is an especially rare form of Morgagni hernia. To the best of our knowledge, only 6 cases of this condition have been reported in the English literature, as diagnosed prenatally [2,3] . Such an intrapericardial hernia probably occurs as a result of failure of the retrosternal portion of the septum transversum to close the communication between the pericardial and peritoneal cavities.…”

“…The septum transversum also contributes to the development of the diaphragm, liver, and pericardium. Although the detailed developmental mechanism of pericardial effusion is unclear, there are three proposed theories: (1) mechanical irritation of the pericardial mass, (2) venous obstruction in the liver leading to congestion and transudation, and (3) compression of the thoracic duct causing the accumulation of lymph [2,3] . The absence of cardiac tamponade is presumed to be related the slow accumulation of the fluid.…”

Diagnosis and management of fetal intrapericardial Morgagni diaphragmatic hernia with massive pericardial effussion

“…Although this is a rare variety of CDHM, its presence must be suspected in cases with unexplained fetal hydropericardia. Prenatal diagnosis of CDHM hernia is not frequent, and the correlation with clinical outcome remains unclear, although cases reported so far reveal high perinatal morbidity and mortality [2,3,7,10]. Cardiac tamponade related to the increased pressure effect could be an expected consequence in fetal CDHM with massive pericardial effusion; however, it has not been reported so far.…”

“…Cardiac tamponade related to the increased pressure effect could be an expected consequence in fetal CDHM with massive pericardial effusion; however, it has not been reported so far. Lung hypoplasia has been described as an associated feature [2,3,7,10]. In fact, bilateral lung hypoplasia was the basic cause of the respiratory failure in previously reported patients [2,3,7,10].…”