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Park, Hwang, Kim, Kim, Yang, Kim, and Jeong: Diaphragmatic Hernia of the Right Hepatic Lobe Mistaken for Diaphragmatic Paralysis in Adult
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Tuberculosis and Respiratory Diseases

Tuberculosis and Respiratory Diseases 2010; 68(5): 298-300.

Published online: 31 May 2010

DOI: https://doi.org/10.4046/trd.2010.68.5.298

Diaphragmatic Hernia of the Right Hepatic Lobe Mistaken for Diaphragmatic Paralysis in Adult

Jung Hyun Park, M.D.1, Ki Eun Hwang, M.D.2, So Young Kim, M.D.2, Hak Ryul Kim, M.D.2, Sei Hoon Yang, M.D.2, Hwi Jung Kim, M.D.2, Eun Taik Jeong, M.D.2

1Department of Internal Medicine, Namyangju Hanyang Hospital, Namyangju, Korea.

2Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea.

Address for correspondence: Jung Hyun Park, M.D. Department of Internal Medicine, Namyangju Hanyang Medical Hospital, 570, Onam-ri, Onam-eub, Namyangju 472-883, Korea. Phone: 82-31-510-0114, Fax: 82-31-510-0123, parkaiver@hanmail.net

Received 16 April 2010       Accepted 21 April 2010

Copyright © 2010. The Korean Academy of Tuberculosis and Respiratory Diseases. All rights reserved.

Abstract

Diaphragmatic paralysis can be demonstrated through diaphragmatic elevation on chest X-ray after thoracic lung surgery or the placement of chest tubing. Additional causes of diaphragmatic paralysis are iatrogenic, mass, atelectasis, etc. For the diagnosis of diaphragmatic paralysis, it required some studies (fluoroscopy, computed tomography [CT], magnetic resonance imaging). Diaphragmatic hernia of the liver is a rare clinical entity, usually found after trauma in adults. Congenital diaphragmatic hernia in neonates requires surgery. Non-traumatic diaphragmatic hernia of the liver in an adult is a rare right-sided diaphragmatic hernia. On developing any symptoms, surgery must be performed. When diaphragmatic hernia is incidentally found in adults without trauma, it is placed under observation for a time period. We diagnosed the diaphragmatic herniation of a right hepatic lobe by 16-slice CT scan without surgery.

Keywords: Hernia, Diaphragm, Liver

Figures and Tables

Figure 1
Right diaphragm elevation on Chest X-ray. (A) 5 years ago. (B) Full inspiration at admission. (C) Full expiration at admission.
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Figure 2
Right diaphragmatic herniation of liver (Bifid liver) on abdomino-pelvic CT. Rt: right; Lt: left.
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Notes

Supported by a grant from Wonkwang University in 2010.

References

1. Ross Russell RI. C 3, 4 and 5, keep the diaphragm alive. Intensive Care Med. 2006. 32:1109–1111.
2. Vassilakopoulos T, Petrof BJ. Ventilator-induced diaphragmatic dysfunction. Am J Respir Crit Care Med. 2004. 169:336–341.
3. McGuigan R, Azarow KS. Living on the edge: current concepts in the management of congenital diaphragmatic hernia. Curr Surg. 2005. 62:390–395.
4. Robertson DJ, Harmon CM, Goldberg S. Right congenital diaphragmatic hernia associated with fusion of the liver and the lung. J Pediatr Surg. 2006. 41:e9–e10.
5. Losanoff JE, Sauter ER. Congenital posterolateral diaphragmatic hernia in an adult. Hernia. 2004. 8:83–85.
6. Luo HF, Lei T, Wang HJ, Tan G, Wang ZY. Non-traumatic diaphragmatic hernia of the liver in an adult: a case report. Hepatobiliary Pancreat Dis Int. 2007. 6:219–221.
7. Daver GB, Bakhshi GD, Patil A, Ellur S, Jain M, Daver NG. Bifid liver in a patient with diaphragmatic hernia. Indian J Gastroenterol. 2005. 24:27–28.
8. Zenda T, Kaizaki C, Mori Y, Miyamoto S, Horichi Y, Nakashima A. Adult right-sided Bochdalek hernia facilitated by coexistent hepatic hypoplasia. Abdom Imaging. 2000. 25:394–396.
9. Sadeghi N, Nicaise N, DeBacker D, Struyven J, Van Gansbeke D. Right diaphragmatic rupture and hepatic hernia: an indirect sign on computed tomography. Eur Radiol. 1999. 9:972–974.
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