Spontaneous Intercostal Lung Hernia

Abstract

Spontaneous lung hernia is an extremely rare disease entity that refers to protrusion of lung parenchyma through a chest wall without trauma or pathologic process. It typically occurs after coughing, through an intercostal defect, and in presence of obesity, chronic obstructive pulmonary disease (COPD), diabetes mellitus, and steroid use. 1 Because surgery is indicated for symptomatic cases, it should be appropriately diagnosed. It can manifest as questionable chest pain without an obvious bulge, warranting imaging in addition to physical examination, while suspecting it is difficult due to its uncommonness. CASE REPORT A 71-year-old man presented with a 3-day history of cough and dyspnea on exertion. He had COPD, obstructive sleep apnea, morbid obesity, hypertension, and dyslipidemia. He was taking atorvastatin but no antithrombotics. He denied Funding: None.

A serious fit of cough: A 66-year-old patient with myasthenia gravis presenting with spontaneous intercostal lung herniation after coughing. Case report and pathophysiological discussion

“…Though a thoracic wall hematoma is frequently associated with lung hernias, it's unspecific for this condition. 3 The initial physical examination was possibly misled by the severe obesity of the patient. Despite the attested sensitivity and specificity of chest ultrasound in the ED for pleural effusions, rib fractures and pneu- mothorax and, therefore, it's possible role in the detection of a lung herniation, 4 the concomitant presence of obesity and subcutaneous emphysema reduced the diagnostic power of lung ultrasound.…”

Hérnia pulmonar intercostal: relato de caso e revisão de literatura

“…Portanto, fatores que aumentem essa pressão estão diretamente relacionados ao maior risco de sua ocorrência, como obesidade, tosse crônica e estágio avançado de doença pulmonar obstrutiva crônica 1 . Ademais, há aumento do risco relacionado a causas de má cicatrização ou fraqueza tecidual, tais como diabetes mellitus, desnutrição, uso de corticoides 10,11 . Nos casos de hérnias pulmonares pós-traumáticas, costuma haver fratura de arcos costais associada, com a consequente lesão da pleura parietal subjacente 12 .…”

Isolated congenital inter-costal pulmonary hernia: a case report

“…On the one hand, it distinguishes congenital pulmonary hernia (20%) from acquired (80%), on the other hand, it distinguishes them according to topography: cervical (17–35%), intercostal (65–83%), or diaphragmatic [3, 9]. Acquired hernias are traumatic, but some spontaneous cases have been reported among patients with some predisposing factors such as a chronic cough, chronic and obstructive bronchopulmonary diseases, neoplasia, chronic use of steroids, and Ehlers–Danlos syndrome [3, 6, 10, 11]. For the congenital forms, an underlying pathology of the ribcage is frequently associated [5].…”