BackgroundA pseudohernia is an abdominal wall bulge that may be mistaken for a hernia but that lacks the disruption of the abdominal wall that characterizes a hernia. Thus, the natural history and treatment of this condition differ from those of a hernia. This is the first report of a pseudohernia due to cough-associated rib fracture.Case presentationA case of pseudohernia due to fractures of the 10th and 11th ribs in a 68-year-old white woman is presented. The patient suffered from a major coughing episode 1 year prior to her presentation, after which she noted a progressively enlarging bulge in her left flank. Computed tomography demonstrated a bulge in the abdominal wall containing bowel and spleen but with all muscle and fascial layers intact; in addition, lateral 10th rib and posterior 11th rib fractures were noted.ConclusionsAs there was no defect in muscle or fascia, we diagnosed a pseudohernia, likely due to a denervation injury from the fractured ribs. Symptomatic treatment was recommended, including wearing a corset and referral to a pain management clinic. Symptomatic treatment is thought to be the mainstay of therapy for pseudohernias, as surgical intervention is unlikely to be of benefit.
Although eight echo T2 determination has less variability and permits slightly better differential diagnosis than most other T2-dependent MR techniques, considerable ambiguity persists that may be due to intrinsic overlap in the T2 relaxation characteristics of the lesions rather than to variability in imaging techniques.
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