Spontaneous Transient Lateral Thoracic Lung Herniation Resulting in Systemic Inflammatory Response Syndrome (SIRS) and Subsequent Contralateral Lung Injury

Abstract

Lung herniation is a relatively rare clinical entity that is most commonly either congenital or acquired traumatically. We describe a case of spontaneous lung herniation secondary to acute cough in an obese male smoker complicated by contralateral acute lung injury and systemic inflammatory response syndrome (SIRS). Mechanisms of lung herniation, classification, diagnosis, and management will be discussed.

Traumatic Lung Herniation following Skateboard Fall

“…To promote migration of lung tissue outside its usual domain there must be weakness or defect in the structural boundaries and sudden or chronic increase in intrathoracic pressure [3, 13]. For cervical herniations, a defect in Sibson's fascia is identified [1].…”

“…Patients with chronic obstructive pulmonary disease (COPD) have classic physiological and anatomical changes that support the development of spontaneous thoracic LHs. In these patients, weakened thoracic cages are often due to chronic steroid use, and promotion of LH is seen with chronic coughing and hyperinflated lungs [3, 6, 13, 14]. …”

“…It is important to include this in the differential diagnosis of patients with a history of chest trauma, thoracic surgery, or persistent pulmonary symptoms. Some patients with LH present with a crepitant chest wall mass that worsens with Valsalva and improves with normal breathing [6, 8, 9, 13]. However, most cases of LH present with nonspecific symptoms such as cough and dyspnea, which suggests LH may be underdiagnosed [5, 6].…”

“…As discussed earlier, LH is rarely life-threatening, but serious complications have been reported including lung tissue strangulation, lung necrosis, pneumothorax, and pneumomediastinum [3, 5–7, 9]. In one case report, a patient developed multiorgan failure after LH resulted in respiratory failure [13]. Suspicion of LH warrants diagnostic imaging.…”

Spontaneous Pulmonary Hernia: A Case Report

“…Patients whose activity involves heavy exertion may also be considered. [9][10][11] Our patient opted for surgery because of persistent pain, hypoxia, and re-infection. After the pericostal suturing and placement of prosthetic material, the patient was without relapse at a 6-month follow-up.…”