Angiotensin converting enzyme inhibitor associated spontaneous herniation of liver mimicking a pleural mass: A case report

• Published in: World journal of hepatology 2022, Vol.14 (4), p.854-859
• Main Authors: Tebha, Sameer Saleem, Zaidi, Zain Ali, Sethar, Sehrish, Virk, Muhammad Asif Abbas, Yousaf, Muhammad Nadeem
• Format: Report
• Language: English
• ISSN: 1948-5182; 1948-5182
• DOI: 10.4254/wjh.v14.i4.854

BACKGROUNDSpontaneous diaphragmatic herniation of the liver is a rare entity. It may mimic pulmonary mass especially in the absence of trauma. Cough is a common side effect of angiotensin converting enzyme (ACE) inhibitors that may cause diaphragmatic rupture due to a sudden increase in trans-diaphragmatic pressure. We present a case of ACE-inhibitor associated spontaneous herniation of the liver mimicking pleural mass. CASE SUMMARYAn 80-year-old woman presented with dry cough for 1 mo and sudden onset of cramping abdominal pain for 1 d. She denied history of trauma, prior surgeries, smoking, alcohol or illicit drug use. She has a history of diabetes and was started on an ACE inhibitor 6 mo ago for the management of hypertension. Examination was remarkable for right upper quadrant tenderness. Lab work-up was unremarkable. Chest X-ray showed a right lower lung opacity suspecting right pleural mass. Chest computed tomography scan ruled out pleural mass, however, revealed herniated right lobe of the liver (3.9 cm × 3.6 cm × 3.4 cm) into the thoracic cavity through the posterolateral diaphragmatic defect. Laparoscopic repair of the diaphragmatic defect was performed and the ACE inhibitor was stopped. Patients' symptoms had completely resolved on follow-up. CONCLUSIONACE inhibitor-associated cough may cause diaphragmatic liver herniation mimicking pleural mass. Early diagnosis, surgical repair and addressing the triggering factors improve patients' outcomes.