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Nogueira Gomes T, Camelo Pereira M, Smith SC, Melgar TA. Lung Herniation Associated With Crack Cocaine Use: An Uncommon Cause of Chest Pain. Cureus 2022; 14:e21801. [PMID: 35261828 PMCID: PMC8892591 DOI: 10.7759/cureus.21801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2022] [Indexed: 11/05/2022] Open
Abstract
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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Stanizzi A, Torresetti M, Salati M, Benedetto GD. Use of porcine acellular dermal matrix to repair lung Hernia after minithoracotomy: A case report with 6-Year follow-up. JPRAS Open 2021; 28:56-60. [PMID: 33732854 PMCID: PMC7937533 DOI: 10.1016/j.jpra.2021.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Lung hernia following minimally invasive cardiac surgery is rare with few reported cases in the literature. Surgical repair is debated, and several methods have been described including a variety of synthetic and biological materials. We report a case of a 36-year-old woman who developed lung hernia and a strong retraction of the pectoralis major muscle after minithoracotomy that was performed for mitral valve surgery. The herniated lung was reduced and the chest wall defect was repaired with a non-cross linked acellular dermal matrix (ADM) anchored to the thoracic wall. At a 6-year follow-up, she was asymptomatic and without recurrence of the hernia. Our experience suggests that ADMs are a safe and reliable surgical technique for lung hernia repair due to their biological and mechanical properties, even in those secondary hernias to minithoracotomy where a complete muscle coverage of the matrix could not be provided.
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Affiliation(s)
- Antonio Stanizzi
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Matteo Torresetti
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
| | - Michele Salati
- Division of Thoracic Surgery, Ospedali Riuniti di Ancona, via Conca 71, 60126, Ancona Italy
| | - Giovanni Di Benedetto
- Clinic of Plastic and Reconstructive Surgery, Department of Experimental and Clinical Medicine, Marche Polytechnic University Medical School, Ancona, Italy
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Cetinkaya A, Zeriouh M, Liakopoulos OJ, Hein S, Siemons T, Bramlage P, Schönburg M, Choi YH, Richter M. Pulmonary herniation after minimally invasive cardiac surgery: review and implications from a series of 20 cases. J Surg Case Rep 2020; 2020:rjaa415. [PMID: 33214867 PMCID: PMC7655012 DOI: 10.1093/jscr/rjaa415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 09/11/2020] [Indexed: 11/13/2022] Open
Abstract
Minimally invasive cardiac surgery (MICS) via right lateral mini thoracotomy is the gold standard treatment approach for mitral and tricuspid valve disorders. Other selected procedures (e.g. transapical aortic valve implantation, MIDCAB) require a left lateral mini thoracotomy for surgical access. Advantages of MICS over complete sternotomy are well known, but access-related complications post MICS, such as pulmonary herniation, are often underestimated/overlooked. In males, a pulmonary herniation in the proximity of the former thoracotomy is often clinically visible, especially when the intrathoracic pressure rises (e.g. during coughing). In females, clinical symptoms may be hidden by the breast and patients often have unspecific complaints or occasional pain when coughing, making identification of a lung herniation more difficult. Chest computed tomography is the diagnostic tool of choice for pulmonary herniations. Using a series of 20 patients with pulmonary herniation post MICS, we report our findings in diagnosis and treatment of this condition.
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Affiliation(s)
- Ayse Cetinkaya
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Mohamed Zeriouh
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | | | - Stefan Hein
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Tamor Siemons
- Department of Radiology, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
| | - Markus Schönburg
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Yeong-Hoon Choi
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
| | - Manfred Richter
- Department of Cardiac Surgery, Kerckhoff-Heart Center, Bad Nauheim, Germany
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Mhamdi S, Aouini I, Daboussi S, Mahfoudhi H, Lassoued MB, Kallel M, Moetamri Z, Aichaouia C, Mejri I, Khadhraoui M, Cheikh R. Intercostal lung herniation secondary to thoracotomy: a case report. Pan Afr Med J 2020; 36:39. [PMID: 32774615 PMCID: PMC7388616 DOI: 10.11604/pamj.2020.36.39.20054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 09/05/2019] [Indexed: 11/18/2022] Open
Abstract
Intercostal lung herniation is defined as a protrusion of the lung parenchyma through a defect in the intercostal muscles between adjacent ribs. The authors report a case of intercostal pulmonary hernia in a 45-year-old male patient, with smoking habit (30 packs-year), presented to the emergency department with dyspnea. He had the history of pulmonary emphysema complicated with a total right pneumothorax in 2015 treated by mini-thoracotomy with bullectomy and pleural abrasion. In 2019, he was admitted to hospital for left chest pain. The computed tomography (CT) scan of the chest revealed a bilateral emphysema with intercostal lung hernia through the fourth intercostal space the patient underwent, a left thoracotomy with repair of the intercostal muscle defect. He was discharged from hospital free of complications.
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Affiliation(s)
- Samira Mhamdi
- Pulmonology Department, Military Hospital, Tunis, Tunisia
| | - Ines Aouini
- Pulmonology Department, Military Hospital, Tunis, Tunisia
| | | | | | | | - Manel Kallel
- Emergency Department, Military Hospital, Tunis, Tunisia
| | - Zied Moetamri
- Pulmonology Department, Military Hospital, Tunis, Tunisia
| | | | - Islem Mejri
- Pulmonology Department, Military Hospital, Tunis, Tunisia
| | | | - Rzaieg Cheikh
- Pulmonology Department, Military Hospital, Tunis, Tunisia
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Ema T, Funai K, Kawase A, Oiwa H, Iizuka S, Shiiya N. Incarceration hernia of the lung after video-assisted thoracic surgery requiring emergency operation: a case report. J Thorac Dis 2018; 10:E541-E543. [PMID: 30174929 DOI: 10.21037/jtd.2018.06.63] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Toshinari Ema
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Kazuhito Funai
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Akikazu Kawase
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Hiroaki Oiwa
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Shuhei Iizuka
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine, Hamamatsu city, Shizuoka, Japan
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Romero C, Varon DS, Surani S, Varon J. Thoracic herniation secondary to pleural effusion. Respir Med Case Rep 2018; 23:96-97. [PMID: 29487789 PMCID: PMC5805847 DOI: 10.1016/j.rmcr.2018.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/09/2018] [Accepted: 01/09/2018] [Indexed: 02/05/2023] Open
Abstract
We present the case of a 61-year-old gentleman with history of stage IV esophageal cancer presented to the emergency department with the complaints of dyspnea on exertion and cough of 1-month duration. Patient had undergone resection of distal esophagus 4 years' prior this admission. Chest radiograph revealed a large right pleural effusion and, a computed tomography scan of the chest revealed a portion of the effusion herniating between the ribs in the right hemithorax. Thoracentesis was performed with improvement in patient's dyspnea and overall condition. Patient was doing better and asymptomatic on his 3-month follow-up. Inadequate closure after surgical procedure can lead to presentation of a lung herniation. This can appear immediately after or many years later. Video-assisted thoracoscopy has been attributed to post-operative presentation of thoracic hernias when compared to more extensive operative procedures.
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Affiliation(s)
- Carlos Romero
- Dorrington Medical Associates, Houston, TX, USA
- Universidad Autónoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Daryelle S. Varon
- Dorrington Medical Associates, Houston, TX, USA
- St. James School of Medicine, British West Indies, Anguilla
| | | | - Joseph Varon
- The University of Texas Health Science Center at Houston, Clinical Professor of Medicine, The University of Texas Medical Branch at Galveston, Chief of Critical Care Services, United Memorial Medical Center, Houston, TX, USA
- Corresponding author. 2219 Dorrington Street Houston, Texas 77030, USA.
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