Early Traumatic Hepatothorax: An Underdiagnose Complication of High Energy Blunt Trauma
Olival CL da Fonseca Neto, Luiz ER Moutinho, Ludmila RO Costa
Citation Information :
da Fonseca Neto OC, Moutinho LE, Costa LR. Early Traumatic Hepatothorax: An Underdiagnose Complication of High Energy Blunt Trauma. Panam J Trauma Crit Care Emerg Surg 2021; 10 (2):82-84.
Aim and objective: This paper reports a case of early traumatic hepatothorax and discusses diagnosis and treatment according to an updated literature review.
Background: Hepatothorax is the abnormal displacement of the liver to the chest. It is a rare condition, which may be challenging to diagnose, and is associated with high energy blunt trauma. Hepatothorax may evolve in different phases: initial, latent, and obstructive; and lead to significant complications and death.
Case description: This paper reports the case of a female patient, 35-year-old, diagnosed with hepatothorax due to a car crash causing a high-energy thoracoabdominal trauma. Due to poor clinical progress after chest drainage, a subsequent helical computerized tomography was done and diagnosed a right diaphragmatic injury and hepatic herniation to the chest. The patient underwent early surgical correction of the diaphragmatic injury and she was later successfully discharged home without complications after a 1-year follow-up.
Conclusion: The literature reports numerous underdiagnosed cases and later surgical correction of traumatic hepatothorax. In this case, persistent dyspnea, despite chest drainage, following a high-energy trauma led to the search and identification of the hepatothorax.
Clinical significance: Physicians should have a high index of suspicion for traumatic hepatothorax in high-energy blunt thoracoabdominal trauma and consider early surgical repair, which is associated with lower morbidity and mortality in this type of injury.
Hirano ES, Silva VG, Bortoto JB, et al. Exame radiográfico convencional do tórax no diagnóstico de hérnia diafragmática pós-traumática. Rev Colégio Bras Cir 2012;39(4):280–285. DOI: 10.1590/S0100-69912012000400007.
Igai H, Yokomise H, Kumagai K, et al. Delayed hepatothorax due to right-sided traumatic diaphragmatic rupture. Gen Thorac Cardiovasc Surg 2007;55(10):434–436. DOI: 10.1007/s11748-007-0158-y.
Lugarinho-Monteiro MTRV, Pereira L, Seco C. Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case. Rev Bras Anestesiol 2018;68(2):190–193. DOI: 10.1016/j.bjan.2016.02.006.
Kumar S, Kumar S, Bhaduri S, et al. An undiagnosed left sided traumatic diaphragmatic hernia presenting as small intestinal strangulation: a case report. Int J Surg Case Rep 2013;4(5):446–448. DOI: 10.1016/j.ijscr.2013.02.006.
Topuz M, Ozek MC. Right ventricle collapse secondary to hepatothorax caused by diaphragm rupture due to blunt trauma. Ulus Travma Ve Acil Cerrahi Derg Turk J Trauma Emerg Surg TJTES 2014;20(6):463–465. DOI: 10.5505/tjtes.2014.27547.
Bader FG, Hoffmann M, Laubert T, et al. Hepatothorax after right-sided diaphragmatic rupture mimicking a pleural effusion: a case report. Cases J 2009(1):2. DOI: 10.4076/1757-1626-2-8545.
Yildar M, Yaman I, Derici H, et al. Laparoscopic repair in simultaneous occurrence of recurrent chronic traumatic diaphragmatic hernia and transdiaphragmatic intercostal hernia. ABCD Arq Bras Cir Dig São Paulo 2015;28(1):90–92. DOI: 10.1590/s0102-67202015000100024.
Ebrahimi G, Bloemers FW. A delayed traumatic right diaphragmatic hernia with hepatothorax. J Surg Case Rep 2012;2012(1):1. DOI: 10.1093/jscr/2012.1.1.
Guner A, Bekar Y, Kece C, et al. Delayed enterothorax and hepatothorax due to missed right-sided traumatic diaphragmatic rupture. Am J Emerg Med 2012;30(1):263.e7-10. DOI: 10.1016/j.ajem.2010.11.016.
Kastanakis M, Anyfantakis D, Kokkinos I, et al. Delayed post-traumatic diaphragmatic rupture complicated by total hepato-thorax: a case report. Int J Surg Case Rep 2013;4(6):537–539. DOI: 10.1016/j.ijscr.2013.03.027.
Baloyiannis I, Kouritas VK, Karagiannis K, et al. Isolated right diaphragmatic rupture following blunt trauma. Gen Thorac Cardiovasc Surg 2011;59(11):760–762. DOI: 10.1007/s11748-010-0759-8.
Quadrozzi F, Favoriti P, Favoriti M, et al. Unusual repair in a rare case of hepatothorax due to right-sided diaphragmatic rupture: case report. Il G Chir 2016;37(2):84–85. DOI: 10.11138/gchir/2016.37.2.084.
Okyere I, Okyere P, Glover PSK. Traumatic right diaphragmatic rupture with hepatothorax in Ghana: two rare cases. Pan Afr Med J 2019. 33. DOI: 10.11604/pamj.2019.33.256.17061.
AL-Naemi AQ, Khan LA, AL-Naemi I, et al. Traumatic right diaphragmatic rupture with hepatothorax: a diagnostic challenge!. Quant Imaging Med Surg 2015;5(6):930–931. DOI: 10.3978/j.issn.2223-4292.2015.07.04.
Panda A, Kumar A, Gamanagatti S, et al. Traumatic diaphragmatic injury: a review of CT signs and the difference between blunt and penetrating injury. Diagn Interv Radiol 2014;20(2):121–128. DOI: 10.5152/dir.2013.13248.
Fiscon V, Portale G, Migliorini G, et al. Laparoscopic repair of intrathoracic liver herniation after traumatic rupture of the diaphragm. Surg Endosc 2011;25(10):3423. DOI: 10.1007/s00464-011-1721-.