Lung Herniation Associated With Crack Cocaine Use: An Uncommon Cause of Chest Pain

Abstract

Lung herniation is an uncommon clinical entity characterized by protrusion of pulmonary tissue through an area of weakness in the chest wall. We present the case of a 56-year-old man with a history of chronic obstructive pulmonary disease (COPD) and crack-cocaine use who presented to the emergency department due to left-sided lateral chest pain, as well as a two-week history of cough, shortness of breath, and wheezing. Chest imaging revealed a contusion on the left flank and intercostal widening with a left-sided pulmonary herniation between ribs 8 and 9. Cardiothoracic surgery was consulted for assessment of pulmonary herniation and recommended conservative management. His pain was managed with multimodal analgesia and the patient was deemed stable for discharge. At outpatient follow-up two weeks later, his pain was well-controlled. To our knowledge, this is the first reported case of pulmonary herniation in which crack cocaine use is implicated as a contributing cause. The outcome achieved in our case supports the use of conservative management with analgesia as a valid strategy for select patients with lung herniation.

“Lung in the Skull”

“…Factors such as emphysema, malnutrition, chronic cough, cocaine and chronic steroid use, weightlifting, or playing a wind instrument seem to play a role in developing nontraumatic lung hernias. 8,9 Iatrogenic postoperative lung hernias have been reported after cardiothoracic surgery, including thoracotomy, thoracoscopy, rib resections, and minimally invasive cardiac procedures. 10 Only a small subset of lung hernias occurs as sequelae of thoracic wall abscess, empyema necessitatis, malignant tumors, and tuberculous osteomyelitis.…”

“…The spontaneous herniation is related to preexisting intercostal muscle weakness and suddenly increased intrathoracic pressure. Factors such as emphysema, malnutrition, chronic cough, cocaine and chronic steroid use, weightlifting, or playing a wind instrument seem to play a role in developing nontraumatic lung hernias 8,9 . Iatrogenic postoperative lung hernias have been reported after cardiothoracic surgery, including thoracotomy, thoracoscopy, rib resections, and minimally invasive cardiac procedures 10 .…”