Different sonographic pictures of traumatic hepatic herniation and reasons for their differences

Sonographic features used in the diagnosis of diaphragmatic rupture with hepatic herniation have been reported in several previous studies. Most of those studies demonstrated the sonographic pictures, but did not discuss the reasons behind the formation of those particular pictures. We report three cases of traumatic hepatic herniation with different sonographic pictures and discuss the reasons for their differences. Case 1 represents a negative sonographic study even though the chest film showed the impression of the hepatic herniation. In case 2, sonography revealed a relatively small volume of herniated liver compared to the larger volume of hepatic herniation seen on chest film. In case 3, a complete illustration of the hepatic herniation in one fused sonographic image included disrupted diaphragm, herniated outline with waist-like configuration of the liver, separation of the liver and right kidney, and interposed bowel gas within the separated area. From these three cases, we can conclude that different locations, narrow or wide constriction of the herniated neck, and different degrees of severity of liver herniation would affect the specific sonographic picture.