Abstract Text
Our patient presented with an acute worsening of chronic gastrointestinal symptoms. A non-contrast CT showed colonic wall thickening and a homogeneous mass near the distal esophagus, initially suspected to be a leiomyoma. Endoscopy was unremarkable, but EUS proved crucial: it revealed an intrathoracic mass composed of hepatic parenchyma extending across the cardia, raising suspicion of hepatic herniation. MRI subsequently confirmed herniation of the left hepatic lobe. Only few cases of non-traumatic intrathoracic hepatic herniation have been reported, and none included an EUS assessment. This case illustrates how EUS, with its dynamic nature and high-resolution assessment of deep structures, represents a valuable diagnostic tool even in rare clinical scenarios. The case highlights also that hepatic herniation may be an incidental finding and should be considered in the differential diagnosis of thoracic masses.