Spontaneous Lung Herniation Leading to Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumopericardium

Hamid, Mohsin; Ghani, Ali; Ullah, Waqas; Sarwar, Usman; Patel, R.

doi:10.7759/cureus.2861

Cited by 7 publications

(22 citation statements)

References 7 publications

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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%

“…Spontaneous lung intercostal hernias (SLIHs) are rare events usually associated with central obesity and chronic obstructive pulmonary disease (COPD) (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). They are classified according to Morel-Lavellee depending on location (cervical, diaphragmatic, and thoracic) and etiology: congenital or acquired (i.e., traumatic, spontaneous, pathological, and iatrogenic) (14).…”

Section: Introductionmentioning

confidence: 99%

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Case Report: Spontaneous lung intercostal hernia series and literature review

et al. 2023

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Spontaneous lung intercostal hernia (SLIH) is a rare condition potentially carrying severe morbidity. About 120 cases have been described so far, with an apparently increasing number of reports in recent years. The main presenting findings are chest pain and bulging, with ecchymosis in the affected area, hemoptysis, respiratory distress, and signs of infection or incarceration being described as well. The gold standard treatment has not been established, and conservative management has been advocated as first-line treatment for asymptomatic patients. Here, we report a case series of five patients, and surgical repair was deemed necessary for four of them either at first evaluation or after failure of conservative management. One patient remains under surveillance and conservative management. We believe that SLIH surgical repair should be considered as first-line treatment for fit patients, due to the uncertainty of its mid- and long-term impact and described pejorative trend/defect enlargement. A proposed algorithm for SLIH management is also presented.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case Report: Spontaneous lung intercostal hernia series and literature review

et al. 2023

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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%

Lung Herniation Associated With Crack Cocaine Use: An Uncommon Cause of Chest Pain

Gomes¹,

Pereira²,

Smith³

et al. 2022

Cureus

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Lung herniation is an uncommon clinical entity characterized by protrusion of pulmonary tissue through an area of weakness in the chest wall. We present the case of a 56-year-old man with a history of chronic obstructive pulmonary disease (COPD) and crack-cocaine use who presented to the emergency department due to left-sided lateral chest pain, as well as a two-week history of cough, shortness of breath, and wheezing. Chest imaging revealed a contusion on the left flank and intercostal widening with a left-sided pulmonary herniation between ribs 8 and 9. Cardiothoracic surgery was consulted for assessment of pulmonary herniation and recommended conservative management. His pain was managed with multimodal analgesia and the patient was deemed stable for discharge. At outpatient follow-up two weeks later, his pain was well-controlled. To our knowledge, this is the first reported case of pulmonary herniation in which crack cocaine use is implicated as a contributing cause. The outcome achieved in our case supports the use of conservative management with analgesia as a valid strategy for select patients with lung herniation.

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“…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%