Chronic cough causing unexpected diaphragmatic hernia and chest wall rupture

Abstract

Cough is a defense mechanism for airway protection and is associated with multiple systemic complications such as ribs fracture. Diaphragmatic rupture is commonly caused by blunt or penetrating trauma. We presented a case of a 72-year-old female with a 1-year history of chronic cough, not responding to medical management. Imaging showing abdominal herniation into the thoracic cavity and rib fracture due to diaphragmatic and chest wall rupture. Abdominal herniation and diaphragmatic rupture were repaired through surgery allowing resolution of symptoms. This is a life-threatening condition with a high-mortality rate in which early diagnosis and repair are desirable. Therefore, awareness of this uncommon complication of cough should be acknowledged.

Multiple rib fractures, pleural effusion and right-sided diaphragmatic herniation of the colon into the chest associated with chronic cough after COVID-19

“…Right-sided ruptures are extremely rare in adults because the liver protects the right hemidiaphragm. Right-sided ruptures are also associated with higher morbidity and mortality [ 1 ] . Due to the risk of strangulation of abdominal organs, early diagnosis and repair are prudent [ 11 ] .…”

“…Cough is one of the most common symptoms for which patients seek medical assistance in the outpatient setting in the USA [ 1 ] . Cough is a notorious symptom of SARS-CoV-2 infection that can persist for weeks or months [ 2 ] .…”

Diaphragmatic Rupture and Gastric Perforation in a Patient with COVID-19 Pneumonia

“…COVID-19 can present with different clinical scenarios ranging from flu-like symptoms with fever, dry cough and sore throat to gastrointestinal issues to severe acute respiratory distress syndrome (ARDS) and multi-organ failure with death. Cough can be associated with rib fracture, abdominal herniation and diaphragmatic rupture [5,6] . The most common complication of cough is rib fracture [7] .…”

Management of musculoskeletal pain in patients with idiopathic pulmonary fibrosis: a review

“…Chronic dry coughing and cough paroxysms, associated with dyspnea, may exhaust the respiratory muscles during the expansion and contraction of the thoracic cavity (34), leading to soreness in the shoulders, chest, and upper back. Sometimes, patients feel pain due to ribs injury caused by coughing (35).…”