Medicina (Kaunas)

. 2022 Jan 28;58(2):204. doi: 10.3390/medicina58020204. https://pubmed.ncbi.nlm.nih.gov/35208528/

Acute Respiratory Failure, Ischemic Modifications on Electrocardiogram: Alternative Etiology-A Case of Morgagni Hernia

Agnes Zsuzsánna Szász ^1 2, Enikő Dalma Székely-Vass ³, Gyopár Tunde Lovász ³, Annamária Magdás ^1 4, Loránd Jozsef Ferencz ¹Affiliations expand

• PMID: 35208528
• PMCID: PMC8880076
• DOI: 10.3390/medicina58020204

Free PMC article

Abstract

We discovered a rare pathology described in adulthood, followed by the development of a long asymptomatic evolution, which underlined the importance of multidisciplinary collaboration. We present the case of a 62-year-old female smoker patient, with a known previous medical history of chronic ischemic heart disease, hypertension, chronic obstructive pulmonary disease (COPD), gastric ulcer and gastritis. The patient was rushed to the emergency room (ER) with acute respiratory failure, chest discomfort, ankle and facial edema and a chest X-ray showing a right lower pulmonary lobe consolidation, with an alarming ischemic electrocardiogram (ECG) modification without increasing myocardial cytolysis indicators. This led our medical team to investigate a possible cardiovascular event that might have been in development. After immediate admission, thoracic computer tomography (CT) imaging was carried out, which found a Morgagni diaphragmatic hernia, containing adipose tissue and the hepatic flexure of the colon with approximate dimensions of 50/100 mm. We faced differential diagnostic problems. We knew the subject’s existing cardiac and chronic respiratory tract pathologies from their previous medical history; therefore, multiple investigations and check-ups were carried out. A chest CT and surgery intervention were needed to resolve this case. Subsequently, the acute respiratory failure and alarming ischemic ECG modification disappeared.

Keywords: Morgagni hernia; acute respiratory failure; chest computer tomography (CT); chest discomfort; mimicking ischemia via electrocardiography (ECG).