Cystic Hematoma of the Diaphragm

Abstract

persistent and progressive elevation of the right diaphragm (Fig. 1). A thoracentesis in the right seventh intercostal space yielded 20 cc. of sterile, brownish, turbid fluid which was negative for neoplastic cells. The liver scan was consistent with a space-occupying lesion in the subdiaphragmatic area suggestive of a hemangioma on the anterior surface of the liver. Pneumoperitoneum studies failed to demonstrate air under the right diaphragm. The patient was prepared for surgery and the abdomen was explored. Filmy adhesions were found between the superior surface of the liver and the undersurface of the diaphragm. The liver appeared grossly normal, although a needle biopsy specimen showed evidence of mild cirrhosis. A tense diaphragm was noted and a needle, directed cephalad, was introduced. The aspirate was brownish fluid very similar to the thoracentesis fluid that had been aspirated previously. It was therefore concluded that the pathological condition was in the chest, and the abdominal incision was closed. The patient recovered without incident and a right thoracotomy was performed at a later date. A very tense, thick-walled cyst was found between the leaves of the right diaphragm. The cyst contained about 1,000 cc. of thick, brownish fluid. The wall of the cyst was partially excised, as total excision would have created a very wide defect in the diaphragm, and the remaining rim was marsupialized toward the pleural cavity. The patient’s postoperative course was uneventful and he was discharged from the hospital in good condition. The specimen showed grossly a partially calcified cystic wall containing thick, brownish material. Microscopically there was no lining noted, The wall consisted of fibrous tissue with a large number of erythrocytes. Some areas showed cholesterol clefts with the numerous erythrocytes. DISCUSSION