Non-traumatic Pulmonary Emergencies in the Deployed Setting

A Deployed Soldier Presenting With Dyspnea and Orthopnea Due to a Morgagni Hernia

Shortness of breath is an important complaint in the austere setting with a broad differential diagnosis. The difficulty of deployed patient movement and lack of diagnostic testing at treatment sites complicates its evaluation. This case highlights a young Soldier presenting with shortness of breath caused by a Morgagni hernia. A 25-year-old deployed male presented with a 1-month history of dyspnea with exertion and right-sided chest tightness. After initial diagnoses of bronchitis, later chest radiographs demonstrated a linear opacity in the right middle lobe (RML). The patient was transferred to a higher level of care where a chest computer tomography scan was consistent with Morgagni hernia. Morgagni hernias can present with a wide variety of clinical complaints, including gastrointestinal symptoms, dyspnea, and chest pain. A lack of familiarity among providers who care for adults and the nonspecific nature of the symptoms frequently cause a diagnostic delay in diagnosis. CXR is helpful in this diagnosis, although this case demonstrates that this hernia may appear similar to RML atelectasis or pneumonia.6 Computed tomography remains the modality of choice to confirm the diagnosis, as well as provide anatomical details and rule out complications. While most experts agree that Morgagni hernias should be surgically repaired, the optimal surgical technique remains uncertain.3 Despite its rarity, Morgagni hernia is important to consider in a broad range of clinical presentations. Its nonspecific symptoms, combined with radiographs that can mimic other disease entities, can lead to a delay in diagnosis, mistreatment, prolonged patient suffering, and complications.