Lung Herniation Research Articles

Intercostal herniation of lung and liver in a post-traumatic patient.

Intercostal herniation of lung and liver in a post-traumatic patient.

Chest wall reconstruction with implantable cross-linked porcine dermal collagen matrix: Evaluation of clinical outcomes.

ObjectivesThe aim of the study is to evaluate clinical applications, safety, and effectiveness of a porcine-derived acellular cross-linked dermal matrix biological mesh in chest wall reconstruction.MethodsWe retrospectively analyzed a prospective multicenter database of chest wall reconstructions using a biological mesh in adult patients undergoing operation between October 2013 and December 2020. We evaluated preoperative data, type of resection and reconstruction, hospitalization, 30-day morbidity and mortality, and overall survival.ResultsA total of 105 patients (36 women [34.2%]; mean age, 57.0 ± 16.1 years; range, 18-90 years) were included, they have admitted for: primary chest wall tumor (n = 52; 49.5%), secondary chest wall tumor (n = 29; 27.6%), lung hernia (n = 12; 11.4%), trauma (n = 10; 9.6%), and infections (n = 2; 1.9%). The surgical sites were preoperatively defined as at high risk of infection in 28 patients (26.7%) or as infected in 16 (15.2%) patients. Thirty-days morbidity was 30.5% (n = 32 patients); 14 patients (13.3%) had postoperative complications directly related to chest wall surgical resection and/or reconstruction. We experienced no 30-day mortality; 1-year and 2-year mortality was 8.4% and 16.8%, respectively.ConclusionsBiological mesh represents a valuable option in chest wall reconstruction even when surgical sites are infected or at high-risk of infections. This mesh shows low early and late postoperative complication rates and excellent long-term stability.

Geriatric man with a mass in the chest.

A 91-year-old man with chronic obstructive pulmonary disease (COPD) was sent to the emergency department (ED) from a nursing facility with shortness of breath. He had a 2L oxygen requirement with stable hemodynamics. Physical examination was remarkable for a mass on his right chest, which expanded with exhalation and contracted with inhalation (Figure 1 and 2). The patient reported a mass present on his chest wall for several years after undergoing a mitral valve repair with a right thoracotomy approach. His respiratory polymerase chain reaction (PCR) was notable for parainfluenza virus. Chest x-ray was obtained (Figure 3). Review of the patient's prior imaging revealed a right lung hernia in the 4th intercostal space (Figure 4). Computed tomography (CT) now demonstrated a pneumothorax that included the hernia sac (Figure 5), likely due to bleb rupture in the setting of viral infection and COPD. The patient was managed with placement of a 14F pigtail catheter under ultrasound guidance, avoiding the hernia sac and subdiaphragmatic structures. The chest wall mass reduced with re-expansion of the lung (Figure 6). The catheter was removed on hospital day 4 and patient discharged on day 7. This case demonstrates an unusual presentation of simple pneumothorax with hypoxic respiratory failure in a patient with chronic lung herniation. Lung hernia may be congenital or acquired secondary to trauma, complication of surgery, weakening of intercostal muscles or increased intrathoracic pressure.1 Many are asymptomatic2 and managed conservatively, although surgical repair may be completed.3 Laura J Walker reports no conflict of interest. Michael Sonnier reports no conflict of interest. Christopher Berry reports no conflict of interest.

Chest Wall Reconstruction Utilizing Ovine-derived Reinforced Tissue Matrix

BackgroundChest wall reconstruction can be a challenge. The perfect material does not exist to restore chest wall stability. Synthetic materials have been the mainstay for reconstruction. Biological material use has increased. Recently, we initiated the use of a biosynthetic material for chest wall reconstruction that is composed of ovine-derived extracellular tissue matrix and monofilament polypropylene suture. MethodsWe respectively reviewed all patients who underwent chest wall reconstruction with a biosynthetic material from January 2020 to June 2021. ResultsTwenty-five patients underwent chest wall reconstruction. Median age was 35 years (range, 18 to 68); 64% were men. Indication for reconstruction was tumor resection in 10, chest wall defect after pectus repair in 7, radiation necrosis in 5, chest wall infection in 2, and lung herniation in 1. Infection was present in 28%. Median chest wall defect was 7 × 10 cm (range, 3.5 to 22.5 cm). Bioabsorbable bars were used in combination with the biosynthetic material patch in 15 patients (60%) and biosynthetic material alone in 10; 5 patients underwent myocutaneous advancement flaps. There were no operative deaths. Postoperative complications occurred in 6 patients (24%). Median hospital stay was 5 days (range, 3 to 14). Late complications occurred in 4 patients (16%). No patient had paradoxical motion, chest wall instability, or required biosynthetic material removal at a median follow-up of 12 months (range, 1 to 18). ConclusionsThis novel biosynthetic material combines the benefits of biologic material and polymer reinforcement to provide a more natural chest wall reconstruction compared with mesh products made of synthetic material alone. Early results are promising in this first series in the literature.

Lung Hernia as a Rare Complication of Thoracic Surgery: A Case Series

Lung Hernia as a Rare Complication of Thoracic Surgery: A Case Series

Conservative Management of Traumatic Intercostal Lung Hernia: A Case Report

Pulmonary herniation is an uncommon phenomenon. It has been described sporadically in obscure case reports and rare case series. Owing to its sparse occurrence, a calibrated algorithm for its management does not exist. Even then, the popular consensus advises surgical management comprising prosthetic mesh repair. Hereby, authors report a case of a 24-year-old male, who developed left lung herniation after blunt trauma to the chest wall. Non Contrast Computed Tomography (NCCT) of chest revealed herniation of left lung through 3rd intercostal space, a hernia defect of 1.8 cm and a small left pneumothorax. Patient was managed conservatively with intercostal drainage and was discharged on day 5 of admission. This case report aims to delineate the conditions where conservative management of lung hernias can be undertaken successfully.

Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.

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.

LUNG HERNIATION: A RARE RESULT OF CPR

TOPIC: Lung Pathology TYPE: Medical Student/Resident Case Reports INTRODUCTION: Lung herniation as a result of cardiopulmonary resuscitation (CPR) is a rare condition whereby the pleura-covered lung parenchyma protrudes through a defect in the chest wall. CASE PRESENTATION: A 70-year-old male with a history of end stage renal disease on dialysis and heart failure presented to the hospital with three weeks of progressive dyspnea and diagnosed with pulmonary edema. He was started on hemodialysis for volume removal. On hospital day four, the patient developed cardiac arrest, and was found to be in hemorrhagic shock, with massive hemorrhage from his dialysis fistula. The patient underwent high quality chest compressions while receiving standard advanced cardiac life support and a massive transfusion protocol. After return of spontaneous circulation and control of the bleeding, a right chest mass was palpated. Imaging demonstrated multiple consecutive right anterior rib and costochondral junction fractures resulting in flail chest and a large anterior herniation of the lung with an associated moderate hemothorax. A thoracostomy tube was offered as was surgical fixation; however, the patient's family decided to pursue comfort measures. DISCUSSION: Lung herniation is an extremely rare entity first described in association with CPR in 1986. Since then, there have been only seven cases of lung herniation after CPR reported in the literature. Furthermore, an occurrence with chondrosternal disruption is even more uncommon, such as our patient with flail chest. When providing high-quality chest compressions, traumatic injuries to the sternum and ribs is often unavoidable and rate of injury does not vary based on medical training of compressor nor patient factors such as age and gender. However, certain comorbidities place patients at increased risk for traumatic lung herniation including COPD and obesity. Chest tube drainage of associated hemothorax may result in spontaneous reduction of the herniated lung. Otherwise, early surgical fixation should be pursued as it is associated with low morbidity and excellent prognosis. There is no consensus on management with concurrent flail chest. Clinicians should include lung herniation in the differential of a patient with recent chest trauma from CPR, when confronted with worsening respiratory symptoms or worsening ventilatory mechanics, as intervention is necessary. CONCLUSIONS: Lung herniation is a rare phenomenon that may be the result of high-quality CPR, especially in patients with the aforementioned risk factors. We believe the incidence of this thoracic pathology will increase as the at-risk population continues to rise thus emphasizing the importance of clinician recognition of this condition as early surgical fixation may provide a definitive treatment. REFERENCE #1: Batra AK. Lung herniation after CPR. Crit Care Med. 1986;14(6):595-6. doi: 10.1097/00003246-198606000-00022. PMID: 3709206. REFERENCE #2: Deliliga, A., Chatzinikolaou, F., Koutsoukis, D. et al. Cardiopulmonary resuscitation (CPR) complications encountered in forensic autopsy cases. BMC Emerg Med 19, 23 (2019). https://doi.org/10.1186/s12873-019-0234-5 REFERENCE #3: Allen GS, Fischer RP. Traumatic lung herniation. Annal Thoracic Surg. 1997;63(5):1455–6. doi: 10.1016/s0003-4975(97)00109-4. DISCLOSURES: No relevant relationships by Andrew Deitchman, source=Web Response No relevant relationships by Jesse Liou, source=Web Response No relevant relationships by John Nawrocki, source=Web Response

TRAUMATIC CHEST WALL INJURY WITH DIAPHRAGMATIC RUPTURE AND LUNG HERNIATION

TOPIC: Cardiothoracic Surgery TYPE: Medical Student/Resident Case Reports INTRODUCTION: Traumatic diaphragmatic injuries are a rare injury that can occur after chest wall trauma. Injury to the diaphragm and its surrounding structures can easily be missed as the patients often have polytrauma. We present a case of a penetrating injury with blunt traumatic chest wall injury with diaphragm rupture and herniation of the left lung through the chest wall after a motorcycle collision. CASE PRESENTATION: A 24-year-old male presented to the hospital as a trauma alert after a motorcycle crash. The patient was found to have a large open chest wound with exposed lung and diaphragm. He was taken for CT imaging and found to have a left apical pneumothorax, left lung contusion, left rib fractures 2-10, and a grade 2 spleen laceration. The patient was taken for emergent exploration of his left chest wound. The patient was found to have disruption of his left chest wall and diaphragmatic attachments with rupture of the lateral aspect of his diaphragm at the level of rib 5-6. The wound was explored with evidence of injury to the left inferior lateral lobe of his lung. The lung did not require any resection. The entire left diaphragm was examined with the central tendon of the left diaphragm found to be intact, the diaphragm was repaired along the lateral edge and reattached to the costal cartilage laterally along the chest wall. The left chest was washed out and a chest tube was placed. The patients remaining hospital course was uneventful, and his chest tube was removed with no signs of air leaks. DISCUSSION: There are no specific signs of diaphragmatic injury or rupture on physical exam. Missed diaphragmatic injuries can result in major morbidity or mortality for the patient. All diaphragmatic injuries should be examined along with all surrounding structures at the time of diagnosis. Most diaphragmatic injuries occur on the left side as the right side is protected by the liver. We highly recommend CT imaging to examine the upper abdomen and chest. In the case of our patient which is rare, we were able to visualize his chest wall injury with his diaphragmatic injury on physical exam. When diagnosed early we recommend repair through the abdomen, but if found late repair through the chest is a better approach. In our case we were able to re-approximate the diaphragm to the chest wall. CONCLUSIONS: Traumatic injuries to the diaphragm can be tough to diagnose at times when there is not obvious injury noted to the diaphragm. We recommend full exposure of the diaphragmatic surface and examination of the surrounding organs and structures to rule out further injury that is not obvious on first examination. The diaphragm should be repaired and then reattached to the chest wall along its costal cartilage laterally. Complete repair with reattachment will allow the patient to avoid morbidity and mortality of a chronic diaphragmatic injury that could lead to impaired respiratory or chest wall function. REFERENCE #1: DeBarros, M., Martin, M.J. Penetrating Traumatic Diaphragm Injuries. Curr Trauma Rep 1, 91-101 DISCLOSURES: No relevant relationships by Michael Bishop, source=Web Response No relevant relationships by Alyssa Ritchie, source=Web Response

Chest Wall Reconstruction for the Treatment of Lung Herniation and Respiratory Failure 1 Month after Emergency Thoracotomy in a Patient with Traumatic Flail Chest

We report a case of delayed chest wall reconstruction after thoracotomy. A 53-year-old female, a victim of a motor vehicle accident, presented with bilateral multiple rib fractures with flail motion and multiple extrathoracic injuries. Whole-body computed tomography revealed multiple fractures of the bilateral ribs, clavicle, and scapula, and bilateral hemopneumothorax with severe lung contusions. Active hemorrhage was also found in the anterior pelvis, which was treated by angioembolization. The patient was transferred to the surgical intensive care unit for follow-up. We planned to perform surgical stabilization of rib fractures (SSRF) because her lung condition did not seem favorable for general anesthesia. Within a few hours, however, massive hemorrhage (presumably due to coagulopathy) drained through the thoracic drainage catheter. We performed an exploratory thoracotomy in the operating room. We initially planned to perform exploratory thoracotomy and “on the way out” SSRF. In the operating room, the hemorrhage was controlled; however, her condition deteriorated and SSRF could not be completed. SSRF was completed after about a month owing to other medical conditions, and the patient was weaned successfully.

Congenital pulmonary hernia secondary to absence of ribs

Congenital lung hernia is extremely rare with less than 50 reported cases.We report two cases of lung hernia, secondary to congenital absence of ribs – A 4‐year‐old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month‐old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified.

Safe implementation of robotic-assisted minimally invasive direct coronary artery bypass: application of learning curves and cumulative sum analysis.

BackgroundLearning curves are inevitably encountered when first implementing an innovative and complex surgical technique. Nevertheless, a cluster of failures or complications should be detected early, but not deter learning, to ensure safe implementation. Here, we aimed to examine the presence and impact of learning curves on outcome after robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB).MethodsA retrospective analysis of the first 300 RA-MIDCAB surgeries between July 2015 and December 2020 was performed. Learning curves were obtained via logarithmic regression for surgical time. Cumulative sum (CUSUM) analysis was performed for (I) major complications including MI, stroke, repeat revascularization, and mortality, and (II) other complications, including prolonged ventilation, pneumonia, pleura puncture, lung herniation, pericarditis, pleuritis, arrhythmia, wound complications, and delirium. Expected and unacceptable rates were set at 12% and 20%, respectively, for major complications, and at 40% and 60% for other complications, based on historical data in conventional coronary artery bypass grafting (CABG).ResultsDemographic characteristics did not differ between terciles, except for more smokers in the first tercile, and less hypercholesterolemia and more complex procedures in the third tercile. The mean surgical time for all operations was 258±81 minutes, ranging from 127 to 821 minutes. A learning curve was only observed in the first tercile. Subgroup analysis revealed that this learning curve was only observed for procedures consisting of single internal mammary artery (SIMA) with 1 or 2 distal anastomoses but not with bilateral internal mammary arteries (BIMA) or more than 2 distal anastomoses. CUSUM analysis showed that the cumulative rate of major and other complications never crossed the lines for unacceptable rates. Rather, the lower 95% confidence boundary was crossed after 50 cases, indicating improvement in safety.ConclusionsThese results suggest that integration of RA-MIDCAB in the surgical landscape can be safely achieved and complication rates can quickly be reduced below those expected in traditional CABG. Collective experience plays a key role in overcoming the learning curve when more complex procedures and cases are introduced.

Complications, and requirement of opioid use after rib fractures, an analysis of 1074 patients

Aim: This study was aimed to evaluate the risk factors, associated complications, opioid requirements, and mortality rates of rib fractures. Materials and Methods: Patients with rib fractures who were admitted to the emergency department between January 1, 2016, and December 31, 2020, were retrospectively analyzed. Patients' demographic data, rib fracture characteristics, trauma mechanism, associated complications, length of stay in the hospital, and in-hospital mortality were recorded. Results: A total of 1074 patients were included in the study. Most of the patients were male (n = 748, 69.6%) and the mean age was 53.89 ± 15.31 years. The mean number of fractured ribs was 3.65 ± 2.06. All patients with diaphragm laceration, atelectasis, pneumonia, ARDS, pneumomediastinum, lung herniation, flail chest, and empyema had six or more rib fractures. Comparison of died and survived patients showed statistically significant differences for age, gender, side of rib fracture, number of fractured ribs, and accompanying another organ injury. A moderate-strong correlation was found between the number of fractured ribs and pneumothorax, hemothorax, chest tube, opioid use, and length of stay in the hospital. Conclusion: Increased number of fractured ribs were associated with increased complications, opioid use, and length of stay in the hospital. The mortality rate was 8.8% in patients with 6 or more fractures. In-vehicle traffic accidents were the most common mechanism. Many of the rib fractures can be prevented if the measures are improved.

Spontaneous lung herniation or acquired atraumatic lung herniation?

Spontaneous lung herniation or acquired atraumatic lung herniation?

Lung Herniation and Torsion Contributing to Persistent RV Dysfunction after Heart-Lung Transplant

<h3>Purpose</h3> Lung herniation and torsion are rare and life-threatening complications post-lung transplant, resulting in vascular compromise, airway obstruction and eventual necrosis. Timely diagnosis is imperative as delays can potentiate ischemia of the lung tissue, increasing morbidity and mortality. Few case reports of lung herniation post-dual heart-lung transplant (HLTx) have been published. We present a unique case of a HLTx complicated by retrocardiac lung herniation and torsion. <h3>Methods</h3> 50 y.o. M with bronchiectasis, cor pulmonale, and severe pulmonary HTN underwent HLTx. He was extubated to nasal canula within 24 hours, however remained vasoplegic requiring inotropic and pressor support, with TTE showing RV dysfunction. On POD 5, pressors were weaned off, however, inotropic support was still required despite normal oxygenation and chest radiograph without acute infiltrates. Further evaluation with bronchoscopy showed extrinsic, pulsating compression of right lower lobe (RLL) "fish-mouth" inlet with inability to pass bronchoscope (Figure 1A). Emergent CT chest revealing RLL torsion and retrocardiac herniation into contralateral hemithorax (Figure 1B). <h3>Results</h3> Patient taken to OR for de-torsion and herniation reduction, with intraoperative bronchoscopy confirming correct anatomical position (Figure 1C). <h3>Conclusion</h3> Acute RV failure accounts for 50% of post-operative complications and 20% of early mortality post-HLTx. Although airway complications are generally confined to the anastomosis, the heart may be compressed by adjacent structures, including a malpositioned lung lobe, and may present as cardiac dysfunction. Early recognition of unique complications, as seen in this case, is critical as vascular and airway compromise may result in irreversible lung damage. De-torsion and reduction of the herniation may allow for full recovery; however, if it fails or is unable to be performed, patients may require a lobectomy to protect the remaining viable lung tissue.

Extensive rib resection followed by thoracic wall reconstruction using polytetrafluoroethylene mesh and titanium plates for refractory intercostal artery bleeding induced by severe blunt thoracic injury: report of a case.

Massive hemothorax due to multiple rib fractures and intercostal artery (ICA) injuries is one of the most lethal forms of chest trauma. Urgent thoracotomy is required; however, suturing is sometimes difficult owing to the limited operative field in the thoracic cavity and because the transected ICA retracts between the surrounding intercostal muscles. We present a patient with refractory ICA bleeding induced by severe blunt thoracic injury successfully treated with extensive rib resection followed by thoracic wall reconstruction using GORE® DUALMESH® and titanium plates. A 66-year-old woman attempted suicide by diving into the path of a train. She incurred massive left hemothorax associated with multiple rib fractures and severe trauma to her extremities; both upper limbs and left leg at the thigh were nearly disconnected. Initially, she underwent urgent left anterolateral thoracotomy followed by partial lung resection and suture hemostasis of the thoracic wall. Subsequently, interventional radiology was performed for the ICA bleeding, and her extremities except her right leg were amputated. However, because hemothorax persisted, and because of the comminuted fractures, we removed the fifth to eighth ribs, and the ICA vascular sheath was ligated. Resecting multiple ribs caused deformities and lung herniations, although hemostasis was achieved. On the third postoperative day, thoracic reconstruction using Gore-Tex® Dual Mesh and titanium plates was performed. Although a small empyema occurred, it was controlled with antibiotics and drainage. Paradoxical respiration and atelectasis did not occur, and the patient was moved to the hospital for continued care in a lucid state.

Video shows the lung herniation on expiration and recession in inspiration.

Video shows the lung herniation on expiration and recession in inspiration.

Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation.

ObjectiveTo describe the anatomic locations and imaging features of posterior lung herniation in unilateral pulmonary agenesis and aplasia, focusing on radiograph-CT/MRI correlation.Materials and MethodsA total of 10 patients (seven with pulmonary agenesis and three with pulmonary aplasia, male: female = 1:9, mean age 7.3 years, age range from 1 month to 20 years) were included. Chest radiographs (n = 9), CT (n = 9), and MRI (n = 1) were reviewed to assess the type of lung underdevelopment, presence of anterior and posterior lung herniation, bronchus origin, supplying artery, and draining vein of the herniated lung.ResultsPulmonary agenesis/aplasia more commonly affected the left lung (n = 7) than the right lung (n = 3). Anterior lung herniation was observed in nine of the 10 patients. Posterior lung herniation was observed in seven patients with left pulmonary agenesis/aplasia. Two patients showed posterior lung herniation crossing the midline but not beyond the aorta, and five patients showed the posteriorly herniated right lower lobe crossing the midline to extend into the left hemithorax farther beyond the descending thoracic aorta through the space between the esophagus and the aorta. This anatomical configuration resulted in a characteristic radiographic finding of a radiolucent area with a convex lateral border and a vertical medial border in the left lower lung zone, revealing a tongue-like projection on CT and MRI.ConclusionPosterior lung herniation occurs in unilateral left lung agenesis/aplasia. Approximately 70% of the cases of posterior lung herniation reveal a unique radiolucent tongue-like projection in the left lower lung zone on imaging studies, which is caused by the extension of the posteriorly herniated right lung farther beyond the descending aorta.

P19 Spontaneous Lung Herniation or Acquired Atraumatic Lung Herniation (AALH)?

Herniation of the lung is a rare phenomenon with no reported cases in Australia. It is defined as a protrusion of pleura-covered lung parenchyma through the thoracic wall and no antecedent injury. We present a unique case of lung herniation at a tertiary centre in regional Australia supplemented by an up-to-date literature review.