Hepatothorax in a Previously Eupneic Patient: A Case Report

The diaphragm is a thin, wide muscle that forms two domes (right and left) that separate and connect the thorax and abdomen, allowing the passage of structures located in both cavities.It is also involved in the ventilatory function, being the main muscle in this physiological process.The above explains the dynamism of this muscle, which during its function is exposed to changes in pressure exerted by both cavities within, what corresponds to its biomechanics and physiology.The diaphragm muscle is prone to traumatic injuries due to its anatomical location and its biomechanics; among these conditions, diaphragmatic hernia stands out, whose etiology is quite broad, including diaphragmatic hernias secondary to trauma.Posttraumatic diaphragmatic hernias (PTDH) are rare but often underdiagnosed, especially on the right side, causing significant morbidity and mortality if not treated promptly.Case description: We present the case of a 47-year-old male patient who arrived at the emergency department after a fall from a height of 3 m, presenting multiple traumas, including closed thoracoabdominal trauma complicated by posttraumatic right diaphragmatic hernia, presumptive diagnosis by simple chest X-ray standing posteroanterior (PA) projection, in addition to presenting with symptoms characterized by abruptonset dyspnea with desaturation, presence of dullness on physical examination of the right hemithorax with absence of vesicular murmur at the right lung base in one patient.Therefore, it was decided to take the patient to the operating table, where a solution of continuity in the right diaphragmatic dome was evident, which conditions the passage of the right lobe of the liver through the defect into the thoracic cavity.After surgical resolution of the pathology, the patient successfully completed his postoperative period without thoracoabdominal repercussions.Conclusion: This case report shows the difficulties associated with the initial diagnosis of a posttraumatic diaphragmatic hernia, given its florid clinical features and possible differential diagnoses that act as distractions, where if we do not have the necessary paraclinical studies, it is unlikely to make the diagnosis early.In this case, we can demonstrate the importance of the initial suspicion of the pathology according to the mechanism of the trauma and the imaging findings, making the decision to offer an emergency surgical resolution, managing to treat the injury in a timely manner, avoiding possible complications and achieving a satisfactory evolution.Clinical significance: Right-sided PTDH with displacement of any segment or lobe of the liver is an underdiagnosed condition due to its rarity and nonspecific clinical presentation, given that there are multiple complications associated with this condition and hence the importance of making an early diagnosis, despite the difficulties it may present.This case emphasizes the need for greater clinical suspicion and the role of imaging studies in the identification and treatment of this potentially lethal condition.