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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Angiotensin converting enzyme inhibitor associated spontaneous herniation of liver mimicking a pleural mass: A case report
Sameer Saleem Tebha, Zain Ali Zaidi, Sehrish Sethar, Muhammad Asif Abbas Virk, Muhammad Nadeem Yousaf
Sameer Saleem Tebha, Department of Neurosurgery and Neurology, Jinnah Medical and Dental College, Karachi 75600, Sindh, Pakistan
Zain Ali Zaidi, Department of Medicine, Jinnah Medical and Dental College, Karachi 75600, Sindh, Pakistan
Sehrish Sethar, Department of Radiology, Jinnah Medical and Dental College, Karachi 75600, Sindh, Pakistan
Muhammad Asif Abbas Virk, Department of Medicine, Division of Gastroenterology, Well Span York Hospital, York, PA 17403, United States
Muhammad Nadeem Yousaf, Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, United States
Author contributions: Sethar S identified the abnormality and diagnosed the patient; Tebha SS and Zaidi ZA reviewed the literature, found relevant information, and wrote the manuscript; Virk MAA and Yousaf MN proofread, revisions and edits of the manuscript, and overall supervision in finalizing of the manuscript.
Informed consent statement: Informed consent was acquired from the patient before writing and publishing this case report and all accompanying images.
Conflict-of-interest statement: All the authors declare that there is no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Muhammad Nadeem Yousaf, MD, Academic Fellow, Doctor, Department of Medicine, Division of Gastroenterology and Hepatology, University of Missouri, One Hospital Drive, Columbia, MO 65212, United States. muhammad.n.yousaf@health.missouri.edu
Received: November 20, 2021
Peer-review started: November 20, 2021
First decision: January 12, 2022
Revised: February 3, 2022
Accepted: March 26, 2022
Article in press: March 26, 2022
Published online: April 27, 2022
BACKGROUND
Spontaneous 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 SUMMARY
An 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.
CONCLUSION
ACE inhibitor-associated cough may cause diaphragmatic liver herniation mimicking pleural mass. Early diagnosis, surgical repair and addressing the triggering factors improve patients’ outcomes.
Core Tip: Diaphragmatic herniation of the liver secondary to angiotensin converting enzyme inhibitors induced cough is uncommon. Cough is a rare cause of diaphragmatic liver herniation and it may be overlooked. This case illustrates the importance of combining clinical presentation with cross-sectional radiological imaging for early diagnosis and surgical repair of diaphragmatic liver herniation and for better patient outcomes.
