術前に診断しえたMorgagni孔ヘルニアの1例  [in Japanese] A CASE OF MORGAGNI' FORAMEN HERNIA DIAGNOSED PREOPERATIVELY  [in Japanese]

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Abstract

血管造影検査で術前に診断しえた大網のみを内容とするMorgagni孔ヘルニアの1例を経験したので報告する.症例は64歳,女性.住民検診で縦隔腫瘍を疑われ当院に紹介された.胸部X線で右心臓横隔膜角に手拳大の腫瘤影を認めた.胸部CTで胸骨後部の心陰影の右側に接して脂肪濃度の腫瘤影を認めた.胸部MRI矢状断で心膜と前胸壁に接して腹腔内と連続する脂肪濃度の腫瘤影を認めた. Morgagni孔ヘルニアが疑われたが,縦隔腫瘍も否定できないため血管造影検査を施行した.腫瘤影へ走行する右胃大網動脈の大網枝が確認できた.以上より大網のみを内容とするMorgagni孔ヘルニアと診断し手術を行った.手術は経腹的に大網を還納し,ヘルニア嚢を腹腔内へ反転切離後,ヘルニア門を閉鎖した.本症の診断に血管造影検査が有用であると考えられた.

A case of Morgagni's foramen hernia involving only the greater omentum which was preoperativery diagnosed by angiography is reported. A 64-year-old woman was referred to the hospital with a suspicion of having a mediastinal tumor at a mass screening medical examination. Chest x-ray film revealed a fist-sized tumor shadow at a corner of diaphragm in the right heart. Chest CT visualized a tumor shadow of fat density adjacent to the right side of cardiac shadow behind the sternum. On sagittal plane of chest magnetic resonance imaging (MRI), a tumor shadow of fat density which was adjacent to the pericardium and anterior thoracic wall and communicated with the abdomen was confirmed. Morgagni's foramen hernia was suspected, but a possibility of mediastinal tumor could not be ruled out. So an angiography was performed and an omental branch of the right gastroepiploic artery along the tumor shadow was revealed. From these findings, the patient was diagnosed as having Morgagni's foramen hernia containing only the greater omentum and was operated on. At operation, the greater omentum was reduced by an abdominal approach, and the hernial openning was closed after the hernial sac was resected from the abdominal cavity. In the diagnosis of the disease, angiography is very valuable.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 60(12), 3143-3147, 1999-12-25

    Japan Surgical Association

References:  12

Cited by:  5

Codes

  • NII Article ID (NAID)
    10008498890
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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