Clinical Communications: AdultsHerniation of the Lung: A Case Report
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
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Cited by (11)
Incidental discovery of intercostal pulmonary hernia: A case report
2022, Radiology Case ReportsCitation Excerpt :In addition, MIP images, allow to exclude strangulation of the lung parenchyma or infarction of the pulmonary vessels. Volume-rendered 3-dimensional reconstructions visualize the entire thoracic involvement and can be extremely useful in assessing the extent of disease, which is paramount for surgical planning and management [1,6,17–19]. Thoracic ultrasound can be useful in the diagnosis of pulmonary hernias when CT is not immediately available or if the presentation is atypical.
Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
2022, Radiology Case ReportsCitation Excerpt :This is thought to be due to the lack of support from the trapezius, latissimus dorsi, and rhomboid muscles at this location in the thorax [4,11]. Lateral herniations are also uncommon due to the presence of both internal and external intercostal muscles but may occur with trauma [5]. One report described lung herniation occurring at the site of a previous chest tube placement [4].
Thoracic herniation secondary to pleural effusion
2018, Respiratory Medicine Case ReportsSurgical vs. nonsurgical management of post-traumatic intercostal lung herniation in children
2018, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Herniation in adults usually occurs anteriorly, adjacent to the sternum, or rarely posteriorly near the vertebrae. These locations are areas where the intercostal space is covered only by external intercostal muscles making it susceptible to injury [10,20,24,28,35]. In contrast, based on our literature review, lung herniation in pediatric patients tends to occur along the anterior chest (81%) and is a consequence of either intercostal muscular disruption due to severe focal trauma (eg. bicycle handle bar injury), or costochondral separation at the sternum (eg. fall from a height).
Lateral lung hernia following a low-energy trauma without bony injuries: A case report
2016, International Journal of Surgery Case ReportsLung hernia provoked by a cough fit
2015, Revue de Pneumologie Clinique