Soft tissue, fat, or air density along heart border
Usually located in right cardiophrenic angle and anterior to heart on lateral view
Smoothly marginated with silhouetting of heart border
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CT and MR Findings
Defect in retrosternal part of diaphragm with hernia sac extending upwards
anterior to heart
Hernia sac most often contains only omental fat
Can also contain: Transverse colon > liver > small bowel > stomach
Hernias in adults usually contain omental fat; involvement of bowel or liver more likely in children
With pericardial defect, hernia sac may protrude into pericardial cavity or heart may protrude downwards
TOP DIFFERENTIAL DIAGNOSES
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Mediastinal and thoracic masses
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Pulmonary parenchymal lesions
CLINICAL ISSUES
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Rare, 3-4% of all diaphragmatic hernias
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Most cases are diagnosed in adults
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Often asymptomatic in adults, and more likely symptomatic in children
Symptoms often include chronic GI complaints
Related
Diagnostic Imaging_ Gastrointes - Michael P Federle
