Pulmonary Hernia Research Articles

Thoracic hernias: What the radiologist should know.

Thoracic hernias encompass the protrusion of thoracic contents through the thorax or intra-abdominal tissue into the thorax. They can be classified as diaphragmatic hernias - either congenital or acquired; pulmonary hernias - involving tissue protrusion through cervical fascia or intercostal spaces; and mediastinal hernias - including cardiac, intrapericardial and hiatal hernias. Prompt identification and classification of thoracic hernias rely on diagnostic imaging, primarily through computed tomography and magnetic resonance, to identify associated complications. This article comprehensively reviews thoracic hernias and their key imaging features.

Poland syndrome: a case report

Poland syndrome is characterized by the absence or hypoplasia of other chest muscles: small pectoral muscle, anterior tightened muscle, grandorsal muscle, and deltoid muscle. Anomalies of the thoracic cage: agenesis or hypoplasia of one or more costal segments, pectus carinatum, excavatum, clavicular hypoplasia, pulmonary herniation. Abnormalities of the mammary region: agenesis or hypoplasia of the breast, areola and nipple. The reported incidence of Poland’s syndrome ranges from 1 in 7,000 to 1 in 100,000. Males are affected more frequently by a 2:1 to 3:1 ratio Poland’s syndrome has also been diagnosed in 1 of 19,000 mammograms. The right side of the body was found to be involved in 60% to 75% of patients - associated malformations: genitourinary malformations, cardiac malformation, hepatic and biliary tract malformations. Case report Our case involves a 7-month-old boy with no medical history of cardiac or respiratory complaints. This is a male child with around 65cm height, and 7kg weight. There is no family history of consanguineous marriage and no family history of congenital anomalies. All siblings are alive and healthy. The child’s milestones are within normal limits. There is aplasia of the right sternocostal head and clavicular heads and abdominal head of the pectoralis major muscle, there is a hypoplasia of the right nipple and breast and absence of subcutaneous fat on the same side. Ribs are visible on the right chest wall. Physical examination shows no history of hand and digit anomaly and no rib anomalies. Chest wall asymmetry with right chest wall showing depression on axillary floor. The anterior axillary fold is absent. On attempting abduction of the shoulder, it shows the absence of the sternocostal head of the pectoralis major.

Cervical pulmonary hernia: a differential diagnosis of thyroid nodule to keep in mind

Cervical pulmonary hernia: a differential diagnosis of thyroid nodule to keep in mind

Giant Pulmonary Herniation: A Late and Rare Complication of Minimally Invasive Lung Biopsy for Interstitial Lung Disease

Pulmonary herniation is the protrusion of the lung parenchyma beyond the normal limits of the thoracic cavity. It is a rare entity. In general, the defect in the chest wall is accompanied by increased intrathoracic pressures in the formation mechanism. Usually the cause is blunt-penetrating thoracic trauma, violent cough or previous thoracic surgery with insufficient closure of the chest wall. We report a case with giant pulmonary herniation that developed four years after biopsy in a patient diagnosed with usual interstitial pneumonia by VATS. Although this is a very rare condition in the literature, one of the late and rare complications of diagnostic pulmonary resections with awake VATS may be caused giant pulmonary herniation

Case Report of Complex Chest Wall Repair for Sternal Dehiscence After Bilateral Lung Transplantation

We report a case of a complex chest wall reconstruction because of sternal dehiscence, requiring different surgical procedures for its complete resolution. A 54-year-old man patient with Langerhans cell histiocytosis and chronic obstructive pulmonary disease underwent bilateral sequential lung transplantation through a clamshell incision, using nitinol thermo-reactive clips for sternal closure. One year later, he consulted because of chest pain, fever, and purulent secretions. Physical examination and chest X-ray revealed a right pulmonary hernia due to post-clamshell wound dehiscence. Chest wall repair was performed, placing an expanded-polytetrafluoroethylene synthetic mesh, and the sternum was realigned and fixated with titanium plates and screws. However, in the immediate postoperative period, there was a large amount of serous drainage through the surgical wound, needing negative pressure therapy. Unfortunately, the wound became necrotic with exposure to the osteosynthesis material. In addition, a chest computed tomography scan showed fluid accumulation in the anterior chest wall. Therefore, two-stage revision surgery was indicated: first, the removal of the previous prosthesis and, the definite one, the use of a pedicled latissimus dorsi myocutaneous flap to provide effective coverage of the wound. Sternal dehiscence is not an uncommon complication after clamshell incision in patients undergoing bilateral sequential lung transplantation, and it is associated with significant morbidity. In the presence of chest wall instability, surgical repair is mandatory.

Spontaneous pulmonary herniation in post-polio syndrome.

Pulmonary hernias are typically a result of trauma, thoracic operations, or congenital defects. Spontaneous lung hernias without a prior overt injury are notably rare. The presence of spontaneous lung hernias has not been reported in post-polio syndrome. Post-polio syndrome is a late sequela of poliomyelitis that usually presents 30-40years after the initial illness with new presentations of progressive muscle weakness, abnormal muscle fatigue, muscle atrophy, and myalgia. This case report describes the presentation and imaging of a post-polio patient with an atraumatic, spontaneous lung hernia. A discussion on pulmonary hernias, diagnostic imaging, and management is also included.

Modification of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant in the surgical treatment of widespread destructive pulmonary tuberculosis

An observation from practice is given – surgical treatment of a patient with widespread destructive pulmonary tuberculosis due to a modified technique of transsternal occlusion of the main bronchus by plastic surgery of the anterior mediastinum with a mesh implant. Patient A., 37 years old, has been suffering from pulmonary tuberculosis for 2 years. She was admitted to the clinic with complaints of shortness of breath during exercise (mrc 3), cough, back pain. On computed tomography of the chest organs: a picture of fibrous-cavernous tuberculosis of the left lung with extensive mediastinal pulmonary hernia. The patient underwent transsternal occlusion of the left main bronchus with plastic surgery of the anterior mediastinum with a polymer mesh implant. The result of the treatment was the stabilization of the process and the clinical cure of the patient.

Giant asymptomatic pulmonary herniation following minimally invasive mitral valve replacement

Minimally invasive valve procedures have become the standard procedure for valvular surgery. Right thoracotomy is the preferred incision for mitral or tricuspid interventions. Complications regarding thoracotomy are almost always either overlooked or ignored. Pulmonary herniation is not that infrequent, but mostly asymptomatic or masked. Pulmonary herniation through thoracotomy incision is the most common presentation and is usually in a limited area. Herein, we present a 62-year-old female patient with giant pulmonary herniation that did not cause any respiratory issues following minimally invasive mitral valve surgery. No treatment was required for pulmonary herniation. She was only given full medical therapy for heart failure.

Successful surgical treatment of mediastinal lung hernia with a mesh implant. Consequent results

An observation from practice is given – surgical treatment of mediastinal pulmonary hernia in a patient after pneumonectomy using the method of anterior mediastinal plastic surgery with a mesh implant with demonstration of long-term results.The patient I. 31 years old was ill with pulmonary tuberculosis for 3 years, treatment was carried out, against which the stenosis of the left main bronchus progressed. The patient underwent endoscopic operations: argonoplasmic destruction of the left main bronchus, balloon dilation of the left main bronchus, with a temporary effect. Due to recurrent stenosis of the left main bronchus, a pneumonectomy was performed on the left. After 7 months, she complained of severe shortness of breath at rest. Computed tomography revealed a displacement of the mediastinal organs to the left, an upper-anterior pulmonary mediastinal hernia of the right lung to the left midclavicular line at the level of the anterior I-IV intercostals on the left. The patient underwent plastic surgery of the anterior mediastinum on the right using a polymer mesh implant. As a result of treatment, after 3 years, radiologically stable restoration of the position of the only right lung in its hemithorax. The patient is functionally compensated, shortness of breath is not observed. The patient has completely returned to her usual lifestyle.

Staged Surgical Treatment of Patients with Destructive Pulmonary Tuberculosis with pre-XDR Using Anterior Mediastinal Plasty

The presented observation describes an example of effective treatment of the patient with disseminated destructive pulmonary tuberculosis with preXDR. The treatment included staged surgery using the original method of anterior mediastinum plasty with a mesh implant.The treatment resulted in the following outcomes: stabilization of the tuberculous disease, persistent sputum conversion, minimization of overdistension of the only lung, absence of mediastinal pulmonary hernia and no deterioration of respiratory function.

Reduction of the risk of bronchopleural complications after pneumonectomy due to the use of intraoperative laser treatment of the stump of the main bronchus

Purpose of the study: due to the intraoperative technique of treating the stump of the main bronchus with a high-energy laser LSP-30 during pneumonectomy, to increase the effectiveness of the treatment of patients with destructive widespread pulmonary tuberculosis.Materials and methods. The results of treatment of 112 patients were analyzed. All patients underwent lung removal due to widespread destructive tuberculosis. Patients were divided into main and control groups. The first group, the main one, consisted of 58 patients selected prospectively with a high risk of bronchopleural complications, of which 63.8% (n = 37) of patients had signs of hemoptysis and episodes of pulmonary hemorrhage, which required urgent and sometimes emergency surgical intervention. In 36.2% (n = 21) of patients, limited empyema of the pleural cavity without bronchopleural fistulas was determined radiographically. All patients of the main group after the stage of lung removal before the formation of a stump, the mucosa of the main bronchus was irradiated with a high-energy laser LSP-30 with a wavelength of 930 nm. 54 patients of the control group, selected retrospectively, in whom the course of the fibroticcavernous tuberculosis passed without complications and the HA stump after pneumonectomy was formed without the use of laser irradiation. There were no endoscopic signs of active tuberculous inflammation of the tracheobronchial tree in patients of both groups. A number of patients, in the main group in 5.2% (n = 3) and in the control group in 3.7% (n = 2), showed signs of scarring of the bronchus after tuberculosis. These patients, as part of preoperative preparation, underwent endoscopic biopsy of the main bronchus mucosa in the scar areas, and only after histological confirmation of the absence of active tuberculous inflammation, pneumonectomy was performed.Results. Pronounced post-thoracotomy pain syndrome in 5.2% (n = 3) of patients in the main group and in 9.3% (n = 5) of patients in the control group, for the relief of which narcotic analgesics were used for a long time. Progression of respiratory insufficiency, as a result of accession of nonspecific pneumonia of the only lung in 5.2% (n = 3) of patients of the main group and in 7.4% (n = 4) of patients of the control group, which was resolved by additional resuscitation and avoided mortality. Formation of residual pleural cavity on days 7–21 of the postoperative period in 6.9% (n = 4) of patients in the main group and in 1.8% (n = 1) of patients in the control group in the apex of the hemithorax, which required several sessions of thoracocentesis for the complete elimination of residual pleural cavity. The formation of a pulmonary hernia and the displacement of the mediastinal organs towards fibrothorax, in 5.2% (n = 3) of patients in the main group and in 1.8% (n = 1) in patients of the control group, this complication is the main manifestation of postpneumonectomy syndrome. Progression of tuberculosis in the only lung in 5.2% (n = 3) of patients of the main group and 3.7% (n = 2) of patients in the control group. This complication was revealed radiographically, despite the anti-tuberculosis therapy carried out in the postoperative period in accordance with the sensitivity of Mycobacterium tuberculosis, identified from the surgical material. Intrapleural bleeding in the early postoperative period was detected in 3.7% (n = 2) of patients in the control group, and no such cases were detected in the main group. All cases of intrapleural bleeding in the control group were urgently stopped.Conclusions. The effectiveness of surgical treatment of patients with widespread destructive pulmonary tuberculosis in the volume of pneumonectomy using intraoperative laser treatment of the mucosa of the main bronchus was 98.3%, while in the control group, where the intraoperative technique was not used, it was significantly lower – 87.1% (p < 0.01). A high percentage of cases of histological detection of an inflammatory process on the resection line is a scientifically substantiated confirmation of the need for intraoperative laser treatment of the main bronchus mucosa by the proposed method in patients with widespread destructive tuberculosis during pneumonectomy.

THE FIRST EXPERIENCE OF THORACOSCOPIC HERNIOPLASTY FOR INTERCOSTAL PULMONARY HERNIA (CLINICAL OBSERVATION AND LITERATURE REVIEW)

A pulmonary hernia is a protrusion of the lung through a defect in the surrounding tissues, a rather rare pathology and each clinical case is of scientific interest. The first description of this rare pathology was performed by Roland in 1499. About 300 observations have been described in the world literature, most of the publications are isolated cases of observation of this pathology. We have presented the first experience of thoracoscopic hernioplasty in the Russian Federation for intercostal pulmonary hernia, and also summarized the literature data on this topic.

Combined Disruption of the Thoracic Spine and Costal Arch Fracture: An Indicator of a Severe Chest Trauma.

Blunt high-energy chest trauma is often associated with thoracic and abdominal organ injuries. Literature for a hyperextension-distraction mechanism resulting in a costal arch fracture combined with a thoracic spine fracture is sparse. A 65-year-old male suffered a fall from a height of six meters. Initial X-ray of the chest shows left-sided high-riding diaphragm and CT scan proves anterior cartilage fracture, posterolateral serial rib fractures, traumatic intercostal pulmonary hernia, avulsion of the diaphragm, and 7th thoracic vertebral fracture. An exploratory thoracotomy was performed and the rupture of the diaphragm, creating a two-cavity injury, had been re-fixed, the pulmonary hernia was closed, and locking plate osteosyntheses of the fractured ribs including the costal arch were performed. We generally recommend surgical therapy of the thorax to restore stability in this severe injury entity. The spine was fixed dorsally using a screw-rod system. In conclusion, this thoracovertebral injury entity is associated with high overall injury severity and life-threatening thoracoabdominal injuries. Since two-cavity traumata and particularly diaphragmatic injuries are often diagnosed delayed, injuries to the costal arch can act as an indicator of severe trauma. They should be detected through clinical examination and assessment of the trauma CT in the soft tissue window.

An example of successful treatment of advanced tuberculosis with simultaneous correction of postpneumonectomy mediastinal pulmonary hernia with a polymer mesh implant

An observation from practice is given – surgical treatment of a patient with widespread tuberculosis of the only left lung and a pronounced displacement of the mediastinal organs into the right hemithorax. Patient P., 43 years old, has been suffering from pulmonary tuberculosis for 11 years, 8 years ago, a pneumonectomy on the right side was performed due to fibrouscavernous tuberculosis of the right lung. According to computed tomography of the chest organs, upon admission, a picture of cavernous tuberculosis of the lower lobe was noted, a pronounced displacement of the mediastinal organs and the only left lung to the right. She was admitted to the clinic with complaints of shortness of breath at rest, weakness, dizziness. The patient underwent resection of a lung containing a cavity with simultaneous correction of the mediastinal pulmonary hernia with a mesh implant. Histological examination of the removed preparation revealed a high level of activity of tuberculous inflammation. As a result, the manifestations of dyspnea decreased in the patient, radiographically, the only left lung was visualized in the hemithorax of the same name.

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.

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.

Pulmonary hernia after thoracoscopy: case report

Pulmonary hernia after thoracoscopy: case report

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.

Extralobar pulmonary sequestrations hiding congenital diaphragmatic defects: A case series

Background: Association between pulmonary sequestration and diaphragmatic hernia is well known. Extralobar sequestrations are masses of the non-functioning lung, surrounded by separate pleura, without bronchial communication, and with a systemic arterial blood supply. They may be placed in the thorax, within the diaphragm, or rarely in a sub-diaphragmatic position. Case Series: We present three cases of extra-lobar extra-thoracic pulmonary sequestrations associated with different types of diaphragmatic defects. In none of the three cases, the diaphragmatic defect was detected prenatally. Conclusion: Pulmonary sequestration may be involved in the embryological origin of the diaphragmatic defect. Simultaneously, it acts as an anatomical barrier and prevents the herniation of the abdominal content into the thorax. If extralobar pulmonary sequestration is diagnosed prenatally, a coexistent diaphragmatic hernia should always be considered.

SPONTANEOUS LUNG HERNIATION AFTER SNEEZING

SESSION TITLE: Medical Student/Resident Cardiothoracic Surgery Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Lung herniation is defined as a protrusion of the pulmonary tissue and pleural membranes beyond the confines of the thoracic cavity through an abnormal opening in the chest wall, diaphragm or mediastinum [1-2]. Pulmonary hernias are extremely rare and usually secondary to a traumatic event, or a surgical procedure. Spontaneous lung herniation is rarely reported in the medical literature. We are presenting a case of spontaneous left lung herniation after an episode of sneezing. CASE PRESENTATION: A 59-year-old man with a past medical history of hypertension, chronic leg edema, and morbid obesity presented with abdominal pain. He reported having a sneeze while sitting and felt popping sensation into his abdomen, followed by severe left lower chest pain and cough. There were no prior infectious symptoms including fever, chills, or night sweats. No associated wheezing or hoarseness of voice. No recent weight changes, worsening of leg edema, orthopnea or paroxysmal nocturnal dyspnea reported. The physical exam is noted to have bruising in the anterior and lateral abdominal wall (Figure 1) with edema and bilateral leg swelling. Laboratory work-up was unremarkable. Computed Tomography (CT) scan of the abdomen and pelvis (Figure 2) showed diffuse anterior wall edema, asymmetrical herniation of the left lung, and adjacent pleural fluid consistent with the diagnosis of left lung herniation into the abdominal wall. He underwent left diagnostic video-assisted thoracoscopic surgery due to persistent refractory chest wall pain. Intraoperative findings were consistent with 4 centimeters (cm) vertical defect between 8th and 9th ribs span the entire length of the chest, approximately 15 cm. Subsequently he underwent left thoracotomy with defect repair. The postoperative course was unremarkable. He was discharged from the hospital without recurring symptoms. DISCUSSION: Spontaneous lung hernia results from an excessive increase in intrathoracic pressure, and strain which forces a portion of the lung through a relatively weak area in the chest wall. Uncomplicated lung hernia can be asymptomatic; however, the common presentation is a soft, tender, subcutaneous mass that enlarges on physical strain or coughing. In the absence of a palpable mass, the Valsalva maneuver will usually cause the bulge to appear. CT scan is necessary to assess the exact location and size of the defect which both will affect the subsequent management. Both surgical and conservative management has been recommended. Asymptomatic hernias usually require no treatment. Increasing size, pain, and any sign of impending incarceration are the main indication for surgical repair. CONCLUSIONS: Lung herniation, despite being uncommon, is important to diagnosis to avoid potential complications of lung tissue strangulation. The clinical presentation and physical examination should raise suspicion and prompt diagnostic workup for lung herniation. Reference #1: Donato AT, Hipona FA, Navani S. Spontaneous lung hernia. Chest. 1973 Aug;64(2):254–6. [PubMed] [Google Scholar] Reference #2: Francois B, Desachy A, Cornu E, Ostyn E, Niquet L, Vignon P. Traumatic pulmonary hernia: surgical versus conservative management. J Trauma. 1998;44:217–9. [PubMed] [Google Scholar] DISCLOSURES: No relevant relationships by Ali Alkhayat, source=Web Response No relevant relationships by Amir Khan, source=Web Response No relevant relationships by Kamran Manzoor, source=Web Response No relevant relationships by Gary Schwartz, source=Web Response