2018
DOI: 10.7759/cureus.2861
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Spontaneous Lung Herniation Leading to Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumopericardium

Abstract: Spontaneous lung herniation is a rare phenomenon in which the lung parenchyma along with the pleural membranes protrudes outside their usual boundaries and can lead to a wide variety of complications. We are reporting a case of a middle-aged male who presented with chronic obstructive pulmonary disease (COPD) exacerbation with severe bouts of cough. Initial computed tomography (CT) chest was unrevealing, but two days later, he developed spontaneous lung herniation, which was initially managed conservatively, b… Show more

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Cited by 8 publications
(22 citation statements)
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“…A plain x-ray in our series showed only a 20% rate of SLIH cases detected in comparison with the 100% detected by CT scan. This is consistent with what was previously published (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Available knowledge on SLIH management is derived from sparse reports either about surgical management or about the conservative approach.…”
Section: Discussionsupporting
confidence: 92%
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“…A plain x-ray in our series showed only a 20% rate of SLIH cases detected in comparison with the 100% detected by CT scan. This is consistent with what was previously published (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Available knowledge on SLIH management is derived from sparse reports either about surgical management or about the conservative approach.…”
Section: Discussionsupporting
confidence: 92%
“…The association with COPD has been postulated as due to chronic coughing and hyperinflation with changes in the intrathoracic and intrabdominal pressures. Steroid use, ultimately, contributes to a weakening of the chest wall (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). The underlying mechanism has been described as being triggered by increased intrathoracic pressures and chest wall forces due to severe cough or straining: a strong bending force on the middle third of the rib is thought to be the result of shearing forces in opposite directions of the serratus anterior and external oblique muscles (15,16).…”
Section: Discussionmentioning
confidence: 99%
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“…Long-term prognosis for lung herniations is generally good, regardless of management. There are several reported symptomatic cases treated successfully with conservative management, and even reports of spontaneous resolution of the hernia [ 1 , 13 , 14 ]. In patients who do not have surgery, pain usually improves over time, and progression of the hernia is rare.…”
Section: Discussionmentioning
confidence: 99%
“…4 Considering the breath of complications with conservative or delayed surgical intervention, we recommend offering surgical repair for all spontaneous lung hernias given the low morbidity and low recurrence rate. 1,2,[4][5][6] The authors propose AALH as an alternative nomenclature that is more accurate to the pathophysiology. Table 1 outlines all reported cases since 1999 of AALH thus establish the risk factors of COPD, smoking history, obesity and long-term steroid therapy.…”
Section: Author Contributionsmentioning
confidence: 99%