A 40-year-old Hispanic female was referred to our center complaining of 6-mo episodes of dyspnea associated with chest pain and abdominal pain located in the right hypochondrium refractory to medical treatment. She denied any previous history of trauma or surgery. There were no positive findings on the physical examination. Computed tomography (CT) revealed a well-circumscribed homogenous soft tissue mass, described as an apparent protrusion of the liver into the thorax of 6 cm, suggesting a diaphragmatic hernia (Figure 1). A right chest wall thoracoscopic was performed, and the operative findings revealed intrathoracic ectopic hepatic parenchyma of 3.5 cm x 2 cm x 1.5 cm, with no evidence of a hernial defect (Figure 2).

Ectopic tissue was resected with an Endo-GIA staple instrument and subsequently diaphragmatic plication and reinforcement of the stapling line. A Pneumokit was placed to prevent the formation of a pneumothorax. The patient had a good evolution after the surgery, a chest X-ray was taken 24 hours after surgery, showing adequate pulmonary expansion. She was discharged 2 days after surgery with no complications. The pathologic report showed ectopic liver with fibrosis, chronic inflammation, and hemorrhage.

Ectopic supradiaphragmatic liver tissue is a rare entity and may sometimes go unnoticed on a radiological examination. This pathology should be considered in symptomatic patients with chronic pain and dyspnea or when diagnosing asymptomatic masses with a supradiaphragmatic location.