Clinical Communications: Adults
Herniation of the Lung: A Case Report

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Abstract

Background

Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia.

Objectives

To discuss the presentation of a patient found to have a spontaneous lung and bowel herniation, and to review the literature regarding these entities.

Case Report

A 61-year old gentleman with a history of chronic obstructive pulmonary disease and previous long-standing smoking history presented with complaints of right-sided chest pain and cough. He was found to have a spontaneous right lateral lung herniation. This was managed expectantly, but the patient subsequently developed spontaneous right-sided diaphragmatic rupture and herniation of bowel contents through the chest wall.

Conclusion

To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.

Introduction

Chest pain is the leading cause of visits to the Emergency Department in the United States (1). Lung herniations are rare but should remain on the list of differential diagnoses for causes of chest pain. This is particularly true if there is a history of prolonged forceful coughing and evidence of chest wall tenderness, ecchymosis, or a protuberance. Herein we present the case of a patient presenting with chronic cough and chest pain who was ultimately determined to have herniations of the lung and colon.

Section snippets

Case Report

A 61-year old gentleman with a history of chronic obstructive pulmonary disease (COPD) and previous 66-pack-year smoking history presented to our Emergency Department (ED) with complaints of a sharp, pleuritic right-sided chest pain. He was hemodynamically stable, but was saturating 90% on room air. Physical examination revealed a slightly overweight gentleman with coarse breath sounds at the right lung base. He was noted to have ecchymosis along the right chest wall tracking down the right

Discussion

Herniations of the lung are uncommon; approximately 300 cases have been documented in the medical literature thus far (4). The true incidence may be higher than reported, given the difficulty in diagnosing this condition and the possibility of asymptomatic hernias. The most frequently used classification system divides lung herniations into congenital and acquired, with the latter being more common. Acquired lung hernias are further classified as traumatic, spontaneous, or pathologic. Trauma

Conclusion

To our knowledge, this is the first case of a spontaneous right-sided lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. Our patient initially presented to the ED with pleuritic right-sided chest pain. He was eventually found to have a right lateral lung herniation. Conservative treatment was attempted initially, with surgical intervention being reserved for persistent symptoms. However, with continued monitoring, the patient was noted to

References (11)

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