Intercostal Lung Herniation Research Articles

Intercostal Pulmonary Hernia Secondary to Defecation Effect

A protrusion of the lung parenchyma through a weakness in the intercostal muscles between nearby ribs is referred to as an intercostal lung herniation. When you cough or strain, a soft, non-tender subcutaneous bulge will become visible. Lung hernias that develop are typically problems following surgery or trauma. They may appear right once following a trauma or surgery or may take time to show up. They could be asymptomatic or, in the case of imprisonment or strangulation, they might manifest as pain and hemoptysis. The present review spotlight the various case study with reference intercostals pulmonary hernia.

P039 INTERCOSTAL HERNIA FOLLOWING DIEP RECONSTRUCTION: A CASE PRESENTATION

Abstract Aim Intercostal lung herniation is a rare clinical condition defined as the protrusion of lung parenchyma beyond the anatomic boundaries of the thoracic wall. Acquired lung hernias are typically occur secondary to trauma or are associated with severe pulmonary disease. We present a case of lung herniation following DIEP breast reconstruction which is the first reported case to date. Material and Methods 40-year-old woman with a history of bilateral mastectomy for breast cancer and subsequent delayed, bilateral DIEP breast reconstruction. She returned to the emergency department four days after her reconstruction with chest pain, shortness of breath and swelling of her chest. CT angiography of her chest demonstrated a focal protrusion of her right lung into her anterior chest wall (Figure 1). Thoracic surgery was consulted for repair which was achieved with a patch technique using Allomax dermal matrix. Results We describe the first reported intercostal lung hernia following DIEP breast reconstruction reported in scientific literature. Our patient had no history of trauma, thoracic surgery or pulmonary disease which are considered the greatest risk factors for acquired intercostal lung herniation. Much like abdominal wall hernias, protrusion of tissue through a small defect places tissue at risk for ischemia. Early recognition is thus essential to avoid tissue loss. Conclusions Intercostal lung hernia is an uncommon clinical entity that has not previously been described as a complication of DIEP breast reconstruction. Its development is associated with significant morbidity including flap loss in this case. Early recognition of this rare complication is essential to avoid more severe sequelae of tissue ischemia.

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

We present a case of a 66-year-old man with history of myasthenia gravis, severe obesity and osteopenia self-presented to our Emergency Department (ED) with severe pain in his left hemithorax, occurred after an episode of cough three days before. No history of trauma was reported. The patient underwent a chest-XR showing uncomplicated spontaneous fractures of the 5th and 6th left ribs. He was therefore discharged with appropriate analgesic treatment. Five days later, the patient came back to our ED for a wide left abdominal hematoma, though hemodynamically stable and eupneic. A CT-scan with contrast showed a rare and unexpected spontaneous left intercostal lung herniation complicated with a diffuse subcutaneous emphysema, pneumothorax, loculated bilateral pleural effusion and abdominal hematoma. The patient was admitted, treated conservatively and safely discharged after two weeks. We also provide a pathophysiological discussion of the case and a literature review.

FAILED CONSERVATIVE MANAGEMENT FOR SPONTANEOUS LUNG HERNIA: WILL SURGERY IMPROVE PATIENT OUTCOMES?

SESSION TITLE: Medical Student/Resident Imaging Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Spontaneous lung herniation (SLH) is a rare entity seen in male smokers with underlying COPD. This most commonly occurs at the 8th and 9th intercostal spaces. SLH can be managed conservatively, surgically with primary repair, or repair utilizing mesh, sternal wires, or sternal plates. The literature is comprised of case reports and small case series. No surgical approach has been established to be superior. However the management of any particular symptomatic patient should be individualized. CASE PRESENTATION: A 72 year old male, former smoker, with past medical history (PMH) significant for COPD with no prior history of thoracic surgery or chest wall trauma, presented to emergency department multiple times over a period of three months with worsening left lower chest wall pain radiating to the back and worsening chronic dyspnea on exertion. He had recurrent admissions for COPD exacerbations over the same time span of 3 months. He received steroids and breathing treatments. He was ultimately found to have a left spontaneous lung hernia as seen on CXR and CT scan. He was initially treated conservatively. However, his symptoms persisted and was referred to thoracic surgery. He underwent thoracotomy with primary repair utilizing sternal wires at a tertiary care center. He developed a DVT and prolonged air leak postoperatively requiring chest tube management. Patient presented 2 months later with a complaint of persistent recurrent chest wall pain and discomfort. Upon physical examination, the recurrent hernia was noted. CT scan of chest confirmed recurrent the left lung herniation and fracture of the sternal wires. The patient elected no further surgical management. DISCUSSION: The true incidence of this rare condition is difficult as many go unnoticed. These patients do not seek medical attention because of minimal symptoms. This may explain the scarce literature and most cases being related to traumatic conditions where imaging is completed as part of the trauma protocol. COPD patients are predisposed because of long-term steroid use, chronic hyperinflation and cough. Clinical presentation varies significantly among cases. Thorough physical examination and imaging studies are warranted for a correct diagnosis. Asymptomatic patients and patients with less severe discomfort could be managed non-operatively to avoid complications. With failure of conservative management, prompt surgical repair should be performed by those with particular expertise. CONCLUSIONS: Our patient’s primary repair failed causing complications with no improvement in quality of life. We hypothesize that surgical repair with mesh may have been superior to primary closure with sternal wires because of hernia recurrence. Reference #1: Cox Michele LT, Thota Darshan, Trevino R: Spontaneous Lung Herniation Through the Chest Wall. Military Medicine. 2018:183(3-4):e233-e234. Reference #2: Wani AS, Kalamkar P, Alhassan S, Farrell MJ: Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma. Oxf Med Case reports. 2015; 2015:378-81. Reference #3: Tack D. Wattiez A et. al. Spontaneous lung hernia after a single cough. Eur. Radiol. 2000 (10) 500-502. DISCLOSURES: No relevant relationships by Stacey Brown-Brocklehurst, source=Web Response No relevant relationships by James Comerci, source=Web Response No relevant relationships by Sathyanarayana Machani, source=Web Response No relevant relationships by Victor Maevsky, source=Web Response No relevant relationships by Trishala Menon, source=Web Response No relevant relationships by Bradley Schmitt, source=Web Response

Intercostal lung herniation mimicking retroperitoneal bleeding in a patient with obstructive sleep apnea treated with continuous positive-pressure ventilation.

Intercostal lung herniation mimicking retroperitoneal bleeding in a patient with obstructive sleep apnea treated with continuous positive-pressure ventilation.

Klebsiella pneumoniae with pathological intercostal lung herniation

Klebsiella pneumoniae with pathological intercostal lung herniation

Isolated congenital inter-costal pulmonary hernia: a case report

BackgroundIntercostal lung herniation is a rare condition that may be congenital (20%) or acquired (80%). The isolated congenital form is exceptional, with one case reported in the literature.Case presentationWe report a case of a 10-year-old French boy of Algeria origin, born with intermittent swelling of his right hemithorax. The swelling and pain gradually increased with age. A clinical examination revealed a localized swelling of his right hemithorax at the level of the midclavicular line and the fifth intercostal space. The swelling increased in size during respiratory movements and enlarged with Valsalva maneuvers. The intercostal lung hernia was treated by thoracoscopy.ConclusionsThis is the second case of isolated congenital intercostal pulmonary hernia reported in the French and English literature. It is the first to be treated by thoracoscopy. Based on this case we performed a review of the diagnosis and therapeutic aspect of pulmonary hernias.

Surgical vs. nonsurgical management of post-traumatic intercostal lung herniation in children

Abstract Background Intercostal lung herniation (ILH) is an exceptionally rare condition in pediatric patients, characterized by disruption of fascial planes and intercostal musculature allowing for protrusion of a portion of the lung parenchyma into this space. In most cases it is a consequence of blunt chest trauma. Due to the rarity of the condition, diagnostic and management approaches are based on the experience in adults, where CT is the most often used diagnostic tool, and surgery is the primary management approach. Recent published experience in adult and pediatric patients supports the use of less invasive imaging and management strategies, particularly in otherwise asymptomatic patients, giving us the opportunity to reconsider our clinical approaches in the diagnosis and management of these patients. Methods We present a recent case of posttraumatic ILH. In addition, we conducted a systematic review of the literature. A search of the PubMed, Embase, Ovid, Scopus and Cochrane databases was conducted using a combination of the following search terms: intercostal lung hernia in children, lung herniation in children, traumatic intercostal lung hernia in children. Two authors independently extracted data, reviewed the abstracts, and assessed them for inclusion in the review. Results All reported cases were single case reports, with total of 16 including our patient. All ILH were unilateral. The most common etiology was bicycle handle bar injury 10 (63%). Herniation was found on the anterior chest wall in 13 (81%) patients, and in 3 (19%) was on the anterolateral chest wall. To confirm the diagnosis chest x-ray was used in 14 (88%) patients, CT chest in 7 (44)%, fluoroscopy in 1 (6%), chest ultrasound in 3 (19%), and in 1 patient there was no imaging documented. Management was surgical in 10 patients (63%) including thoracotomy with primary closure in 8 patients and thoracoscopic repair in 2 patients. Six patients (37%) had nonsurgical management by chest strapping, with complete resolution of herniation within 2–6 weeks. There was no reported complications or recurrence following either type of management. Conclusions Postraumatic intercostal lung herniation in children is a rare condition. Including our case reported here, there are only 16 reported cases. In children ILH is mostly seen after blunt chest trauma caused by bicycle handle bar injury. Given the rarity of the condition, the pediatric literature on this subject is scarce, with no published guidelines or evidence based recommendations for imaging and management approaches (surgical vs. nonsurgical). Although rare, the pediatric surgeon should be familiar with this condition in order to avoid potentially harmful, invasive or unnecessary diagnostic and therapeutic approaches that are extrapolated from experience in adult patients. Noninvasive imaging modalities including chest radiographs and ultrasound, and nonsurgical management of posttraumatic intercostal lung herniation should be considered as an initial treatment option in the management of asymptomatic patients.

A Case of Manual Reduction of Intercostal Lung Hernia after VATS Lobectomy

A Case of Manual Reduction of Intercostal Lung Hernia after VATS Lobectomy

Traumatic Pulmonary Herniation at the Diaphragmatic Junction in a Pediatric Patient

We present a case of traumatic intercostal pulmonary herniation in an 11-year-old boy after blunt trauma to the chest, without associated chest wall disruption or pneumothorax. This condition is especially uncommon in children, with only 5 previously reported cases and most occurring after penetrating chest trauma. To date, there are no reports in literature describing traumatic intercostal lung herniation at the diaphragmatic junction with a closed chest cavity in a child. The number of traumatic lung herniation diagnoses may be expanded by a more liberal use of computed tomography when serious injury is suspected. Computed tomography and advanced imaging should be considered in pediatric trauma patients presenting with concern for intrathoracic injury that may not be seen on plain film. Traumatic blunt intrathoracic and intra-abdominal injuries in the pediatric population that are within proximity of diaphragmatic insertion should be thoroughly evaluated to rule out diaphragmatic injury. As in our case, invasive surgical intervention such as thoracoscopy may be necessary.

Postsurgical Intercostal Lung Herniation

Postsurgical Intercostal Lung Herniation

Delayed Presentation of a Traumatic Intercostal Lung Hernia: A Case Report and Review of the Literature

Introduction: Lung herniation following blunt chest trauma is extremely rare and only a few hundred cases of this pathology have been reported in the English language medical literature. This type of lung hernia is divided into intercostal, parasternal, or supraclavicular subtypes based on the exact location of the chest wall defect. Traumatic intercostal lung hernia is even more uncommon. Delayed presentation of a traumatic lung hernia has been reported in two cases in the medical literature where cases had a delayed presentation of 2-29 days. Case Presentation: We present a case of 72-year-old white male who had a delayed presentation of an intercostal post traumatic lung hernia (PTLH) 50 years after severe blunt chest trauma. Conclusions: This is a rare case of a delayed presentation of a traumatic intercostal lung hernia. Based on our literature search, this case seems to be the first reported case with such a long delay prior to presentation. We suggest that in patients with even a remote history of blunt chest trauma, a physical examination and preoperative evaluation including assessment for possible PTLH be considered before patients undergo positive pressure ventilation. We also suggest that PTLD be considered in the differential diagnosis for patients with blunt traumatic chest injuries and rib fractures.

Intercostal Lung Hernia: A Case for Conservative Treatment

Lung herniation, defined as the protrusion of the lung beyond the thorax, is rarely encountered in the clinical setting. Most pulmonary hernias are caused by congenital defects and thoracic trauma. Spontaneous hernias are uncommon. We present a 70 year old patient with spontaneous intercostal lung herniation following a bout of bronchitis and several days of vigorous coughing. We highlight the pitfalls in establishing a diagnosing, present the outcome with conservative management, review the literature and outline the types, causes, incidence, and treatment options.

Cough-induced intercostal lung herniation

Intercostal lung herniation is an uncommon entity, defined as protrusion of lung tissue between the ribs. The disease is mostly diagnosed either congenitally or acquired following post-surgery or after chest wall trauma. A spontaneous lung herniation is rarely described.

Conservative management of traumatic intercostal lung herniation in a child

Intercostal lung herniation by non-penetrating chest wall trauma is rare in the pediatric population, and only a few cases are reported in the literature. We described a case of a post-traumatic lung herniation in a 9-year-old child, after closed chest trauma by a bicycle handlebar. The diagnosis was made with chest X-ray and mediastinal ultrasound imaging. Surgery is frequently needed to treat a lung hernia. In our case, given the small size of the lung hernia, conservative medical treatment was sufficient and effective.

Severe Mediastinal Emphysema and Tension Pneumothorax Caused by Cough-Induced Intercostal Lung Herniation

We report a case of cough-induced intercostal lung herniation with severe mediastinal emphysema and pneumothorax. A 60-year-old overweight man was admitted with dyspnea, chest pain, and chest wall bulging. Imaging confirmed left pneumothorax, fractures of the 8th to 10th ribs, and a defect in the 8th intercostal muscles. The presence of protrusion of lung parenchyma outside the intercostal space was unclear. Although the symptoms of tension pneumothorax disappeared after drainage, the subcutaneous emphysema was uncontrollable. Emergency surgery revealed lung injury near the 8th rib wedge not directly related to the rib fracture, and lung herniation was observed. We performed direct approximation of the ribs, and the lung parenchymal surface was encased by absorbable materials, avoiding infection risk. Although the lung herniation recurred 5 months later, the patient did not desire additional surgical repair. Non-absorbable materials should be considered for repair of lung herniation, excluding patients at high infection risk.

Symptomatic intercostal lung hernia secondary to sternal dehiscence surgery

Patient: Male, 60Final Diagnosis: Iatrogenic intercostal lung herniaSymptoms: —Medication: No medicationClinical Procedure: Surgically cerrectedSpecialty: Thoracic surgeryObjective:Unusual clinical courseBackground:Iatrogenic intercostal lung hernia is a rare thoracic pathology. Injury of intercostal muscles and costocondral separation during median sternotomy and sternal dehiscence surgery are important factors in the development of hernia. We report for the first time a case of a 60-year-old man with acquired lung hernia after sternal dehiscence surgery, presenting as chest pain and exertional dyspnea.Case Report:A 60-year-old man presented with a 6-week history of progressive exertional dyspnea, particularly following vigorous coughing. Past medical history included slight chronic obstructive pulmonary disease and coronary artery bypass grafting surgery 8 weeks previously, using the left internal mammary artery for the left anterior descending artery via median sternotomy and sternal dehiscence by the Robicsek method. A chest X-ray showed intact sternal and parasternal wires, but the bilateral lung parenchyma appeared normal. A spiral computed tomography scan of the chest found intercostal herniation of the anterior segment of the left upper lobe. The lung hernia was repaired surgically to relieve exertional dyspnea and incarceration, and to improve respiratory function. The postoperative course was uneventful and the patient recovered well.Conclusions:Intercostal lung hernia after median sternotomy and sternal dehiscence surgery is rare, and it has been previously reported on. Preventive techniques include gentle manipulation of the sternal retractor, avoidance of rib fractures, and using a protective method of intercostal arteries and nerves such as Sharma technique. Thoracic surgeons should be aware of this rare complication in sternal dehiscence surgery.

術後創部から発症した肺ヘルニアの1例

症例は56歳男性，54歳時にPort access法，右前側方切開で開胸し大動脈弁置換術を施行された．その後，咳嗽時に術創部の突出と疼痛が出現し，徐々に増悪を認めた．胸部動態CT撮影で，右第3肋間，胸骨右縁から前腋窩線にかけての肋間筋の欠損と，Valsalva手技時における大胸筋下への肺脱出を認め，肺ヘルニアと診断され当科で手術を施行した．術中所見において，同部位に10×2 cmのヘルニア門を認め，ePTFE patchを胸腔側に縫着し，ヘルニア門閉鎖術を行った．肺ヘルニアは比較的稀な疾患であり，今回我々は開胸術後の肋間肺ヘルニアを経験したので，文献的考察を含めて報告する．

Cough-induced intercostal lung herniation successfully diagnosed with imaging techniques

We report the case of a 78-year-old man presenting with pain in right hemithorax that occurred suddenly after coughing. A palpable chest wall mass, soft in consistency, was noted on physical examination, and chest X-ray and CT allowed to make diagnosis of spontaneous lung hernia.

Intercostal Lung Hernia after Pectus Bar Removal

A 27-year-old man presented with chest pain and shortness of breath. A chest radiograph revealed collapse of the right lung (Fig. 1); this was his third episode of ipsilateral pneumothorax during the past 3 years. He had a history of minimally invasive repair of pectus excavatum (MIRPE) at another hospital 11 years earlier, and he had undergone surgery for a bar removal 4 years earlier. The computed tomographic scan of the chest revealed deformed ribs, costal cartilages, herniation of both lungs through the chest walls (Fig. 2), and a huge bulla in the right upper lobe. During surgery, the right lung was densely adhered to the parietal pleura, and the medial segment of the right middle lobe was herniated through the chest wall (Fig. 3). We resected the bulla of the right upper lobe and the herniated portion of the right middle lobe with an endostapler after the adhered lung was dissected free due to air leakages from those lobes. Fig. 1 Chest radiograph showing the right pneumothorax. Fig. 2 Computed tomographic scan of the chest showing herniation (arrowhead) of the right middle lobe (A) and the left upper lobe (B). Fig. 3 Intraoperative thoracoscopic view shows the right middle lobe herniated through the intercostal space. Complications related to a pectus bar such as displacement, infection, and allergy make up most of the late postoperative complications [1]. However, intercostal lung hernia after pectus bar removal is rare, and it has not been previously reported on. The patient had had a pectus bar for 7 years, and it may have caused deformities of the ribs and costal cartilages, especially at the sites where it entered and exited the pleural cavity. As a result, intercostal defects were created on each side of the chest wall, and the lungs may have herniated through these defects. Although this type of herniation usually does not cause pulmonary problems such as a reduction of lung function, they can complicate entering the pleural cavity during surgery in the future.