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Chest mass in a 13-year-old boy
  1. Lokesh Guglani1,
  2. John Broyles1,
  3. Barbara A Gaines2,
  4. Jonathan D Finder1
  1. 1Divisions of Pediatric Pulmonology, Children's Hospital of Pittsburgh, Pittsburgh Pennsylvania, USA
  2. 2Department of Pediatric Surgery, Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
  1. Correspondence to Dr Jonathan D Finder, Divisions of Pediatric Pulmonology, Children's Hospital of Pittsburgh, 4401 Penn Avenue, AOB 3rd floor, Suite 3300, Pittsburgh PA 15224, USA; Jonathan.finder{at}chp.edu

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A previously healthy 13-year-old boy was referred to the pulmonary clinic for evaluation for persistent cough and opacity on chest x-ray after treatment with three different antibiotics. The physical examination was unremarkable and chest x-ray showed opacity (figure 1A) with homogeneous density and sharp margins. Lateral view (figure 1B) suggested that it was anterior to the heart. Chest CT (figure 1C) confirmed anterior position with well-defined margins and no involvement of lung parenchyma. Coronal reverse image (figure 1D) showed a defect in the diaphragm from which abdominal omental fat was seen herniating into the thoracic cavity, suggestive of Morgagni hernia. The patient underwent surgical repair of Morgagni hernia without any complications.

Figure 1

(A) Chest x-ray anteroposterior (AP) view of index case. (B) Lateral view of chest x-ray showing opacity in anterior mediastinum. (C) Chest CT scan confirming the anterior mediastinal position with no involvement of surrounding lung parenchyma. (D) Coronal reverse image shows defect in diaphragm (arrow) through which omental fat is seen herniating into chest cavity.

Morgagni hernias are the least common of all diaphragmatic defects1 and are usually asymptomatic, unless associated with other malformations (cardiac defects, omphalocele, trisomy 21). They are more common on the right side and can contain liver, colon or small bowel (in infants) or just omental fat (in older children and adults). The differential diagnosis of an anterior mediastinal mass lesion2 in a child would include lymphomas, leukaemia, Morgagni hernia, hiatal hernia, thymic tumours and cysts, germ cell tumours, thyroid masses (intrathoracic goitre, thyroid tumours), connective tissue tumours (lipoma, lymphangioma) and pericardial cyst. Therefore, it is important to examine the lateral view film to discern the specific location of an opacity seen on anteroposterior view of chest x-ray. This can help formulate a differential diagnosis based on its location in the chest.

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Footnotes

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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