Morgagni hernia is a defect in the anterior diaphragm between the costal and sternal portions of the muscle [58]. Adult presentation is uncommon and usually an incidental finding on imaging performed for unrelated reasons. Retrospective review series of multidetector CT performed for unrelated indications identified Bochdalek hernia in 10.5% to 12.7% of adults [59,60]. However, these hernias may also present with acute symptoms related to complications of obstruction, perforation, or necrosis of the herniated organs [56,61-63]. CT Chest and Abdomen CT is an efficacious method for the diagnosis of traumatic diaphragmatic hernia with a sensitivity, a specificity, a PPV, an NPV, and an accuracy ranging from 56.5% to 82%, 69.6% to 100%, 69% to 100%, 88.4% to 93%, and 89% to 90.6%, respectively [64-66]. For the diagnosis of congenital hernia, there is particular emphasis on the utility of multiplanar technique [59-63,67- 69]. Data on sensitivity, specificity, and accuracy are not available because the majority of literature is comprised of case reports. There is n o specific data differentiating diagnostic efficacy of IV contrast versus n oncontrast examination. There is no specific data regarding the use of CT without and with IV contrast, but theoretically, the additional information gained between comparison of a noncontrast and postcontrast series would not be beneficial for hernia detection and characterization. Fluoroscopy Upper GI Series Upper GI diagnosed congenital diaphragmatic hernia in one case report of Morgagni hernia [61], and contrast swallow was diagnostic on one reported case of Bochdalek hernia [63]. Fluoroscopy Upper GI Series with Small Bowel Follow-Through There is no relevant literature regarding the use of fluoroscopy upper GI series with small bowel follow-through in the evaluation of diaphragmatic hernia. However, demonstration of abnormal bowel configuration suggesting herniation may be helpful in complex cases.
Hernia. Morgagni hernia is a defect in the anterior diaphragm between the costal and sternal portions of the muscle [58]. Adult presentation is uncommon and usually an incidental finding on imaging performed for unrelated reasons. Retrospective review series of multidetector CT performed for unrelated indications identified Bochdalek hernia in 10.5% to 12.7% of adults [59,60]. However, these hernias may also present with acute symptoms related to complications of obstruction, perforation, or necrosis of the herniated organs [56,61-63]. CT Chest and Abdomen CT is an efficacious method for the diagnosis of traumatic diaphragmatic hernia with a sensitivity, a specificity, a PPV, an NPV, and an accuracy ranging from 56.5% to 82%, 69.6% to 100%, 69% to 100%, 88.4% to 93%, and 89% to 90.6%, respectively [64-66]. For the diagnosis of congenital hernia, there is particular emphasis on the utility of multiplanar technique [59-63,67- 69]. Data on sensitivity, specificity, and accuracy are not available because the majority of literature is comprised of case reports. There is n o specific data differentiating diagnostic efficacy of IV contrast versus n oncontrast examination. There is no specific data regarding the use of CT without and with IV contrast, but theoretically, the additional information gained between comparison of a noncontrast and postcontrast series would not be beneficial for hernia detection and characterization. Fluoroscopy Upper GI Series Upper GI diagnosed congenital diaphragmatic hernia in one case report of Morgagni hernia [61], and contrast swallow was diagnostic on one reported case of Bochdalek hernia [63]. Fluoroscopy Upper GI Series with Small Bowel Follow-Through There is no relevant literature regarding the use of fluoroscopy upper GI series with small bowel follow-through in the evaluation of diaphragmatic hernia. However, demonstration of abnormal bowel configuration suggesting herniation may be helpful in complex cases.