Diaphragmatic hernias: a cause of unilateral loss of the cardiophrenic sinus angle

Abstract

Aim Cardiophrenic space is the most basal portion of the mediastinum and surrounded by heart, diaphragm and chest wall. Cardiophrenic space full with fatty tissue shows a sharp angles. However, some space-occupying lesions, infections, inflammations and diaphragmatic herniation can be the cause of the blunt cardiophrenic sinus angle. The aim of this study is to determine the incidence of loss of the cardiophrenic sinus angle due to diaphragmatic hernias.Methods We retrospectively evaluated 983 consecutive chest multidetector computed tomography images for presence of unilaterally increased fat tissue. 200 patients who had blunting in the cardiophrenic (right or left) sinus were included in the study. Density measurements proved the presence of adipose tissue in the cardiophrenic sinus in all patients. The relationship between age, gender and right or left sided atelectasis and associated diaphragmatic hernias were statistically analyzed.Results 107 patients were female (53.5%) and 93 (46.5%) were male. 28% of patients had diaphragmatic hernia. 31% of females and 24% of males had diaphragmatic hernia. Incidence of the Morgagni hernia was 14.5% and it was significantly higher in females than in males (p<0.05) and overall was lateralized 89% to the right.Conclusion Diaphragmatic defects are usually asymptomatic and asymptomatic diaphragmatic hernias are not rare in older population. In patients with the unilateral cardiophrenic sinus blunting, diaphragmatic hernias must be included in the differential diagnosis. Neighboring atelectasis in the lung parenchyma near the diaphragmatic hernia was a common finding. But it had a low yield for the diagnosis of diaphragmatic hernia.

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