Abstract
We report the case of an adult patient recently diagnosed with cirrhosis. The ultrasound evaluation described a multinodular inhomogeneous liver, requiring a magnetic resonance imaging scan for further characterization. The performed magnetic resonance imaging examination confirmed the diagnosis of cirrhosis associated with portal hypertension and detected a vascular left transdiaphragmatic hernia. Although various types of diaphragmatic hernias have been described - congenital or acquired - to the best of our knowledge, this type of pathology has never been reported.
Highlights
Diaphragmatic hernias appear secondary to structure or insertion abnormalities of the diaphragm and can be divided in two major categories - congenital and acquired hernias
Case presentation We present the case of a 45-year-old white man, with a history of alcohol use (100 to 200 mL alcohol/day for more than 20 years), who was recently diagnosed with cirrhosis after an ultrasound examination
The negative immunological tests corroborated with the imaging investigations and the elevated level of gamma-glutamyltranspeptidase suggest liver cirrhosis with a possible alcohol use etiology
Summary
Diaphragmatic hernias appear secondary to structure or insertion abnormalities of the diaphragm and can be divided in two major categories - congenital and acquired hernias. An echographic examination was performed prior to his admission to our clinic, which revealed a pseudonodular, inhomogeneous liver with fibrotic changes, an enlarged main portal vein with decreased velocity (7.3 cm/s) and multiple venous collateral circulations trajects (recanalized umbilical vein, enlarged mesenteric and perisplenic veins) These findings were suggestive of cirrhosis with vascular decompensation. The MRI sequences showed the inhomogeneous structure of the liver, with a pseudonodular aspect, without signal abnormalities suggestive for neoplastic pathology as well as an irregular liver contour and increased dimensions of the left hepatic lobe and caudate segment His spleen was normal size but with an inhomogeneous structure presenting small granular low signal images on both T1- and T2-weighted sequences, compatible with the microcalcifications described on ultrasound.
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