Spontaneous posterior lung herniation

Abstract

Intercostal lung hernias are uncommon and usually a consequence of trauma or surgery. True spontaneous lung hernias are extremely rare, with only 51 cases identified over the past four-and-half decades. We report a case of nontraumatic chest wall ecchymosis secondary to spontaneous posterior-lateral lung herniation followed by a review of the literature. Interesting radiographic images are presented. The pathophysiology and therapeutic options of this condition are discussed. The case highlights that advanced chronic obstructive pulmonary disease (COPD) may be an etiological factor for the development of this rare entity, with cough being the precipitating event. Given the increasing prevalence of COPD, the authors believe further awareness of this pathology is needed.

Spontaneous pulmonary herniation in COVID‐19

“…First described in 1499, the pulmonary hernia is characterized by the protrusion of the lung, including parenchyma and pleura through a defect in the chest wall 4,5 . The classical features of pulmonary hernias include visible herniation of the chest wall, localized chest pain and flank ecchymosis 1,2,6 . Most lung hernias occur in the context of trauma or post‐operatively.…”

“…Spontaneous pulmonary hernias due to coughing occur owing to dramatically increased intrathoracic pressure causing damage to the chest wall. Risk factors include male gender, obstructive airways disease (COPD/asthma), smoking status, steroid use and obesity 1,2 …”

“…Risk factors include male gender, obstructive airways disease (COPD/asthma), smoking status, steroid use and obesity. 1,2 V I D E O 1 Video demonstrating visible herniation on deep breathing and coughing. Flank haematoma is visible inferiorly to herniation Video content can be viewed at https://onlinelibrary.wiley.com/doi/10.1002/rcr2.1145…”

“…Proposed mechanisms suggest increased intrathoracic pressures during acute coughing fits causing spontaneous rib fractures and subsequent herniation. Risk factors include chronic obstructive pulmonary disease (COPD), obesity, steroid use and smoking 1,2 . Classic features of SPH include chest wall pain on coughing, flank haematoma and bulging of the chest wall on deep inspiration and coughing.…”

Surgical Repair of Spontaneous Lung Herniation Induced by Vigorous Coughing: A Case Report and Literature Review

“…As mentioned before, increasingly more cases of spontaneous lung hernias have been reported in the literature during the last decade [1,2,7,11,[16][17][18][19]. Ugolini et al reported five patients, all of which were males with a median age of 68 years [2].…”