Late-Presenting Left-Sided Morgagni Congenital Diaphragmatic Hernia in a 9-Year-Old Male

Congenital diaphragmatic hernias are common, primarily occurring through the foramen of Bochdalek. However, in contrast, defects through the foramen of Morgagni are much more rare. When late presentations occur, patients may be asymptomatic or may be critically ill with respiratory and gastrointestinal symptoms. In this paper, we present a 9-year-old male who presented with recurrent, vague abdominal pain, and a previously normal abdominal CT scan. Initial investigation via an abdominal radiograph demonstrated an unexpected left lower lobe abnormality. Further evaluation and management revealed this abnormality to be an unusual left-sided congenital diaphragmatic hernia that appeared through the retrosternal foramen of Morgagni, a rare occurrence. 1. Introduction Through the advancement of fetal ultrasound, the diagnosis of congenital diaphragmatic hernias (CDHs) typically occurs prior to delivery. However, 5–25% of cases are late presenting after the neonatal period [1–3]. CDH are relatively common, occurring in approximately 1 in 2500 births, with a majority forming posterolaterally through the foramen of Bochdalek [2]. Diaphragmatic defects retrosternally through the foramen of Morgagni are less common, occurring in only 1–5% of the patients with CDH [2]. These defects tend to be right-sided, in comparison to Bochdalek-type hernias, which are primarily left-sided. We report a case of a 9 year-old male determined to have an unusual left-sided CDH through the retrosternal foramen of Morgagni who presented to our pediatric pulmonary service with a left lower lobe abnormality noted on imaging as part of an evaluation in the Emergency Department for abdominal pain. 2. Case Report A young 9-year-old male initially presented to the Emergency Department complaining of abdominal pain for approximately 3 years with intermittent heartburn symptoms that had been worsening and were unassociated with diet, meals, or exercise. Upon obtaining an abdominal X-ray, a portion of the left lower lobe was visualized revealing an opacity (Figure 1). A chest X-ray was therefore ordered and demonstrated an irregular cystic-appearing thin-walled lucency at the anterior lung base in the left cardiophrenic sulcus and gastroesophageal junction regions (Figure 2). Given the concern for cystic anatomical lung abnormality versus possible herniation of abdominal contents on chest X-ray, a CT scan of the chest was also obtained (Figure 3). Results demonstrated a left, anterior diaphragmatic hernia containing loops of splenic flexure through the left hemithorax. Bowel loops appeared