Computed tomography (CT) on admission demonstrated traumatic aortic injury, multiple rib fractures, and bilateral hemo-pneumothoraces as well as a spiculated mass,

2 cm diameter with pleural indentation in segment 6 of the right lung. She underwent emergent repair of the descending aorta and right pleural drainage. On the fourth post-operative day, bloody drainage from the right chest suddenly increased in volume. The patient was taken back Luminespib solubility dmso to the operating room and at right thoracotomy, a bleeding point was found on the surface of the diaphragm. Hemostasis was established by using polypropylene suture. Four months later, the size of lung mass was unchanged, and PET showed little FDG uptake. Because malignancy was suspected and her general condition improved, she underwent surgical resection of the tumor. After meticulous dissection, the right lower lobe was partially resected, but systematic lobectomy and radical lymph node dissection was

not feasible due to significant adhesion. Histological examination revealed a well-differentiated Combretastatin A4 molecular weight adenocarcinoma with clear tissue margins. The follow-up CT at 3 months revealed MK0683 cell line another tumor in the right lower lobe adjacent to the diaphragm, which had not been recognized before. Twelve months after lung resection, a discrete ovoid mass 3.7 × 2.7 cm in diameter with slightly higher density than that of liver parenchyma was apparent (Figure 1). Subsequent PET showed FDG uptake in the lesion [the maximum standard

uptake value (SUV max) was 3.1] (Figure 2). Metastasis of lung cancer or another heterogenic tumor was entertained as a diagnosis; however, the mass appeared to be contiguous with the liver, which had an identical FDG uptake level. Since liver herniation was suspected, percutaneous needle core biopsy of the mass was performed (Figure 3). The tissue selleck contained only liver cells with inflammatory cell infiltration, and was diagnosed as liver herniation (Figure 4). Because the size of the mass had steadily increased, we elected to perform surgical repair. At operation, diaphragmatic herniation of the liver (3 cm in diameter) was found. The herniated portion of the liver appeared to be congested. As a polypropylene suture was found at the edge of the hernia hilus, we concluded that the hernia had originated from the motor vehicle trauma (Figure 5). The defect was repaired with interrupted sutures. The patient was discharged home after an uneventful recovery and has no evidence of recurrence after two years of follow-up. Figure 1 CT findings of the tumor. The mass in the right lung field with its inferior border abutting the diaphragm (arrow) increased in size over time. A At the first admission. B At 3 months, and C 12 months after the operation for lung cancer. Figure 2 CT and corresponding PET findings of the tumor. A CT before the operation for liver herniation showed a 3.7 × 2.7 cm solid tumor (arrow).