title: [Chronic hepatothorax due to right diaphragmatic rupture: an anesthetic challenge in a rare case].
abstract: BACKGROUND
  Diaphragmatic rupture is an uncommon condition, with 90% of ruptures occurring on the left side. However, its incidence on the right side is increasing along with the increase in traffic accidents. Liver herniation may become progressive causing severe atelectasis of the right lung, resulting in impaired respiratory status and hemodynamic changes.
  
  
  METHODS
  We report the case of a 40 years old female, ASA III, scheduled for hepatothorax repair that evolved from right diaphragmatic hernia after a car accident when she was 8 years old. Clinically, she had severe restrictive respiratory syndrome caused by the hepatothorax. The anesthetic evaluation was normal, except for the chest X-ray showing elevation of the dome of the right hemidiaphragm without tracheal deviation. Diagnosis was confirmed by CT scan. After liver replacement in the abdominal cavity, a transient increase in central venous pressure, stroke volume index and flow time corrected (35%), and a decrease in systemic vascular resistance were observed. After complete hemodynamic and hepatosplenic stabilization, as well as ventilation, the patient was transferred intubated, under controlled ventilation and monitored, to the liver transplant unit.
  
  
  CONCLUSIONS
  Hepatothorax is a rare condition and its repair may represent an anesthetic challenge. After liver replacement in the abdominal cavity during corrective surgery under general anesthesia complications may occur, particularly associated with pulmonary re-expansion. Effective teamwork and careful planning of surgery, between the surgical and anesthetic teams, are the key to success.
authors.affiliation: Serviço de Anestesiologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Electronic address: mteresarvlm@hotmail.com.
authors.forename: Maria Teresa Rincón Vieira
authors.initials: MTRV
authors.lastname: Lugarinho-Monteiro
authors.affiliation: Serviço de Anestesiologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Luciane
authors.initials: L
authors.lastname: Pereira
authors.affiliation: Serviço de Anestesiologia do Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Seco
mesh_terms: D000328:Adult; D000758:Anesthesia; D002908:Chronic Disease; D005260:Female; D006547:Hernia / Q000209:etiology; D006549:Hernia, Diaphragmatic, Traumatic / Q000150:complications / Q000601:surgery*; D059685:Herniorrhaphy; D006801:Humans; D008107:Liver Diseases / Q000209:etiology / Q000601:surgery*
keywords: Anestesia; Anesthesia; Diaphragmatic injury; Hepatotorax; Hepatotórax; Lesão diafragmática