Spontaneous Non-Traumatic Abdominal Wall Herniation of Liver

Abstract

A 55-year-old female presented with cough for the past two years and pain over right posterior lower chest wall for two months. An ill-defined 6 x 4 cm non-tender bulging over right infra-axillary area on the posterior axillary line was noted. The patient denied trauma/surgery to the chest or abdomen in the past. Upon evaluation with high-resolution computed tomography (HRCT) of the thorax and abdomen, bilateral diffuse cystic bronchiectasis along with thinning of posterior abdominal wall of approximately 7cm width with liver parenchyma herniation was noted. The mass was located above the superior lumbar triangle of Grynfelt. When the force of the cough is greater than the elastic limit of the ribs and thoracic and abdominal walls, a prolapse of the organs over the most vulnerable locations can occur. An unnecessary invasive procedure, such as thoracotomy and/or biopsy can thus be avoided based on clinical or radiological diagnosis.