NONTRAUMATIC LIVER HERNIATION MIMICKING A LOWER LOBE LUNG MASS

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: Spontaneous diaphragmatic herniation is a rare type of acquired hernia without any history trauma. (1) We describe case where non-traumatic liver through diaphragm was observed mimicking lower lobe lung mass. CASE PRESENTATION: A 54-year-old female prior thoraco-abdominal trauma seen in the clinic because growth 2 right nodules. These nodules were initially noted incidentally on CT scan August 2009 and measured 1.5 cm x 2.8 0.9 1.3. They remained stable PET performed 2010. Patient lost follow-up after that until she had March 2019 concern pneumonia it have increased size to 4.1 1.1 1.4 cm. The patient otherwise asymptomatic. obtained which showed hypermetabolic with maximum SUV 3.29 for larger smaller nodule respectively. Radiographic appearance as well pattern consistent low-grade malignancy like carcinoid tumor. robotic thoracoscopy plan wedge resection possible completion lobectomy. Gross inspection thoracic cavity revealed abnormal mass dome liver. It be lying oblique fissure corelated position scan. There second area thinned-out small pushing location lesion Tru-Cut needle biopsy benign tissue. decision made not proceed repair or reinforcement mesh this an asymptomatic fibrosed protecting from intestinal herniation. DISCUSSION: review literature (1956-2009) there are 28 reported cases spontaneous rupture (SDH) those only 10% SDH caused by events increase intra-abdominal pressure complicated labor, intense physical exercise, psychiatric illness, cough secondary pertussis. Another predisposing factor congenital defect creates weakness increases likelihood pressure. has also been described association other conditions Ehler-Danlos Syndrome (EDS) endometriosis CONCLUSIONS: Our unique presenting etiologies leading diaphragm. Liver can managed surgical if REFERENCE #1: Losanoff JE, Edelman DA, Salwen WA, Basson MD. diaphragm: report comprehensive world literature. Journal cardiovascular surgery. 2010 Jun 1;139(6):e127-8. #2: Stoica SC, Craig SR, Soon SY, Walker WS. hemidiaphragm video-assisted volume reduction operation. Annals 2002 Sep 1;74(3):929-31. #3: Hamaoui K, Riaz A, Hay Botha A. Massive Ehlers–Danlos syndrome. Royal College Surgeons England. 2012 Mar;94(1):e5-7. DISCLOSURES: no disclosure file Annis Ali; No relevant relationships Muhammad Adeel Samad, source=Web Response Diane Shih-Della Penna, Scott Tiedebohl