Description

An 89-year-old woman presented to the emergency department with cough for the past couple of days. Chest X-ray revealed an area of condensation at the inferior lobe of the right lung, suggestive of pneumonia (figure 1). This image was similar to another X-ray that had been taken the year before. In additional studies, CT scan revealed a large Morgagni hernia with intrathoracic colon on the right and a Bochdalek hernia on the left (figure 2). The patient was discharged with symptomatic medication. Because she improved and had no further symptoms related to the hernias, no surgical treatment was given.

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Figure 1

Chest X-ray.

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Figure 2

Morgagni hernia: (A) axial CT scan showing an air-containing mass (arrowhead) and (B) sagittal reformatted view showing a diaphragmatic defect (arrows) and the herniated intestine. Bochdalek hernia: (C) CT scan showing a posterior left paraspinal fat-containing lesion (arrowhead) and (D) multiplanar reformatted image clearly depicting the diaphragmatic defect and fat herniation without organ entrapment (arrow).

Congenital diaphragmatic hernias are rare anomalies (1/2000 pregnancies) and account for nearly 8% of major birth defects, of which Bochdalek hernia is the most common (95%), being primarily diagnosed in early childhood; Morgagni hernia is less frequent (5%) and is usually identified in adults.1 ,2 The diaphragm defect is on the left in 80% of patients.1 Congenital diaphragmatic hernias occur when there is a development defect of the diaphragm's muscular components, which usually leads to impaired pulmonary function and an early diagnosis in life. However, some patients may not develop symptoms until adulthood.2

The association of both is extremely uncommon and, to the best of our knowledge, these forms of congenital diaphragmatic hernia that develop on both sides and remain asymptomatic until old age have not been previously reported.