Congenital pericardial agenesis and Morgagni hernia in a neonate: A case report

Introduction: Anterior (Morgagni) congenital diaphragmatic hernia and congenital pericardial agenesis in the absence of other defects has yet to be described in a neonate. Case presentation: The patient was a female infant born at term to a mother with delayed prenatal care. Fetal magnetic resonance imaging at 35 weeks gestation showed a cystic lesion in the left lung base that was thought to be a variant of a congenital pulmonary airway malformation. Patient was treated with continuous positive airway pressure at birth but was stable on room air within an hour of life. Patient was asymptomatic and discharged on day 2 of life. Patient remained asymptomatic through multiple follow-ups with pediatric surgery, and imaging consistently showed a cystic mass in the lower left chest. Surgery was performed to resect the pulmonary cystic lesion 6 months after birth. Upon thoracoscopic visualization of the chest, the heart without pericardium was seen herniated into the left pleural space, and a Morgagni hernia with a cystic sac was visualized. The Morgagni hernia was repaired primarily by pediatric surgery, and pediatric cardiothoracic surgery used a Gore-Tex patch to construct the absent left pericardium. Hospital course was uneventful, and the patient was discharged on postoperative day 6. On follow-up 2 weeks after discharge, the patient was asymptomatic, but new elevation of the left hemidiaphragm was seen. Further follow-up is scheduled. Conclusion: The combination of defects seen in this patient has not been previously described, and further follow-up of the hemidiaphragm elevation will be necessary. Long-term complications are not expected.