Current Thoracic Surgery

Heterotopic supradiaphragmatic liver tissue (HSLT) is an extremely rare condition, with about 30 cases documented in the literature since its first description. Because it often shows no symptoms and looks similar to pleural or parenchymal tumors on imaging, HSLT poses a significant diagnostic challenge. Although the cause remains unknown, a definitive diagnosis usually requires surgery. While conservative treatment is suitable for clinically confirmed cases, surgical exploration becomes necessary when malignancy cannot be ruled out. In such cases, the videothoracoscopic approach (VATS) is considered the gold standard for both diagnosis and treatment. Here, we report a case of HSLT discovered incidentally during imaging for acute appendicitis. We review the diagnostic difficulties and recommend VATS as the primary surgical option for unclear lesions above the diaphragm.