1
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de Villa AR, Obeidat O, Oyetoran A, Okonoboh P. Iatrogenic lung hernia, a rare complication of thoracoscopic spinal fusion: A case report and review of literature. Radiol Case Rep 2023; 18:3240-3242. [PMID: 37424771 PMCID: PMC10328798 DOI: 10.1016/j.radcr.2023.06.035] [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: 05/30/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/11/2023] Open
Abstract
A lung hernia is a rare and potentially severe complication that may occur due to thoracic surgery amongst other etiologies. This case report describes the clinical presentation, imaging findings, and management of a patient who developed an iatrogenic lung hernia after undergoing thoracic fusion surgery at the level of T6-T7. The patient presented with persistent chest pain, shortness of breath, and a nonproductive cough. Initial imaging studies revealed the presence of an abnormality within the pleural space, later confirmed through computed tomography of the chest. This case highlights the importance of considering iatrogenic lung hernia as a potential complication of thoracic fusion surgery and the need for close monitoring and prompt intervention in cases when it occurs.
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Affiliation(s)
- Ariel Ruiz de Villa
- UCF College of Medicine HCA Healthcare GME Consortium, 6500 W Newberry Rd, Gainesville, FL 32605, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Omar Obeidat
- UCF College of Medicine HCA Healthcare GME Consortium, 6500 W Newberry Rd, Gainesville, FL 32605, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Anuoluwa Oyetoran
- UCF College of Medicine HCA Healthcare GME Consortium, 6500 W Newberry Rd, Gainesville, FL 32605, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
| | - Peters Okonoboh
- UCF College of Medicine HCA Healthcare GME Consortium, 6500 W Newberry Rd, Gainesville, FL 32605, USA
- HCA Florida North Florida Hospital, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL 32605, USA
- HCA Florida North Florida Hospital, Critical Care Medicine, Gainesville, FL, USA
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2
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Belyayev LA, Parker WJ, Madha ES, Jessie EM, Bradley MJ. Primary Lung Hernia After Blunt Chest Trauma: Chest Wall Repair Strategies. Am Surg 2023; 89:2073-2075. [PMID: 34096350 DOI: 10.1177/00031348211023439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Lung herniation is a rare pathology seen after trauma. A case of acquired lung hernia is presented after blunt thoracic trauma that was repaired primarily. Surgical management and decision-making for this process are discussed.
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Affiliation(s)
- Leonid A Belyayev
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - William J Parker
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Emad S Madha
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Elliot M Jessie
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
| | - Matthew J Bradley
- Department of General Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD, USA
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3
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Leivaditis V, Grapatsas K, Papatriantafyllou A, Koletsis EN, Charokopos N, Dahm M. Surgical Repair of Spontaneous Lung Herniation Induced by Vigorous Coughing: A Case Report and Literature Review. Cureus 2023; 15:e37325. [PMID: 37182085 PMCID: PMC10168014 DOI: 10.7759/cureus.37325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Lung herniation is a rare clinical entity defined by extrathoracic protrusion of the lung or lung tissue due to a weakness in the thoracic wall. We present here a case of a 72-year-old male who presented with a spontaneous lung herniation, which occurred as a result of a ventral luxation of the third rib from the sternocostal joint due to vigorous coughing. The defect was repaired through anterolateral thoracotomy, reposition of the lung and approximating the ribs using heavy sutures. The postoperative course of the patient was uncomplicated. A brief review of the literature is also provided.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen - Ruhrlandklinik, Essen, DEU
| | | | | | - Nikolaos Charokopos
- Department of Cardiothoracic Surgery, Patras University Hospital, Patras, GRC
| | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, Kaiserslautern, DEU
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4
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Ugolini S, Abdelghafar M, Vokkri E, Sharkey AJ, Fontaine E, Voltolini L, Morabito A, Ugolini D, Granato F. Case Report: Spontaneous lung intercostal hernia series and literature review. Front Surg 2023; 9:1091727. [PMID: 36776474 PMCID: PMC9911423 DOI: 10.3389/fsurg.2022.1091727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 12/30/2022] [Indexed: 01/28/2023] Open
Abstract
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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Affiliation(s)
- Sara Ugolini
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust (MFT), Wythenshawe Hospital, Manchester, United Kingdom,Correspondence: Sara Ugolini
| | - Moslem Abdelghafar
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust (MFT), Wythenshawe Hospital, Manchester, United Kingdom
| | - Eduart Vokkri
- Department Thoracic Surgery, University Hospital Careggi, University of Florence, Firenze, Italy
| | - Annabel J. Sharkey
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust (MFT), Wythenshawe Hospital, Manchester, United Kingdom
| | - Eustace Fontaine
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust (MFT), Wythenshawe Hospital, Manchester, United Kingdom
| | - Luca Voltolini
- Department Thoracic Surgery, University Hospital Careggi, University of Florence, Firenze, Italy
| | - Antonino Morabito
- Department of Pediatric Surgery, A. Meyer Children’s Hospital, University of Florence, Firenze, Italy
| | - Dario Ugolini
- Department Thoracic Surgery, University Hospital Careggi, University of Florence, Firenze, Italy
| | - Felice Granato
- Department of Cardiothoracic Surgery, Manchester University NHS Foundation Trust (MFT), Wythenshawe Hospital, Manchester, United Kingdom
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5
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Cherraqi A, El Houssni J, Outznit M, Imrani K, Benelhosni K, Billah NM, Nassar I. Incidental discovery of intercostal pulmonary hernia: A case report. Radiol Case Rep 2022; 17:4510-4514. [PMID: 36189153 PMCID: PMC9519495 DOI: 10.1016/j.radcr.2022.08.068] [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: 08/12/2022] [Accepted: 08/19/2022] [Indexed: 11/18/2022] Open
Abstract
Lung hernias are rare. They are defined by the protrusion of lung parenchyma through a defect in the chest wall. A distinction is classically made between supraclavicular, thoracic or diaphragmatic hernias and congenital or acquired hernias. The latter can be classified by etiology as post-traumatic, postoperative, or pathological but can be spontaneous (even rarer) caused mainly by coughing efforts. The diagnosis is guided by the clinical presentation and confirmed by radiographic analysis, especially CT scan. The management, by conservative or surgical approach, depends on the clinical condition of the patient, the characteristics of the hernia and the existence or not of complications. We report the case of a 58-year-old patient, chronic smoker with no history of trauma, who presented with a chronic cough not improved by symptomatic treatment and in whom the clinical examination was without particularities. Chest CT scan showed discrete pulmonary emphysema with an intercostal pulmonary herniation at the level of the right fifth intercostal space associated with a bony outgrowth at the level of the middle arch of the right fifth rib. The pulmonary protrusion occurred through a parietal defect between the fifth rib and the bony protrusion. The management consisted of conservative treatment of the hernia with close clinical and radiological follow-up and medical treatment of the pulmonary emphysema and chronic cough associated with smoking cessation and hygienic and dietary rules.
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6
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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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7
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Güldoğan ES, Akdağ T. Traumatic lung herniation due to Cow's kick. Trop Doct 2021; 52:165-167. [PMID: 34866502 DOI: 10.1177/00494755211050192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lung herniation, where the lung and its visceral and parietal components protrude outwards from a defect in the chest wall, is not common. It is most commonly secondary to blunt or penetrating trauma. The diagnosis is difficult, as the presentation differs according to aetiology. Ultrasound or CT scanning help in diagnosis and treatment planning. We present a 70-year-old female patient with lung herniation following a cow's kick on the thorax.
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Affiliation(s)
- Esra Soyer Güldoğan
- Department of Radiology, Health Sciences University Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Tuba Akdağ
- Department of Radiology, Health Sciences University Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
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8
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Morales Borrero WJ, Madonado Vargas J. A 64-Year-Old Man with Traumatic Right Middle Lobe Lung Herniation Successfully Managed Conservatively. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e931446. [PMID: 34145210 PMCID: PMC8218886 DOI: 10.12659/ajcr.931446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Patient: Male, 64-year-old Final Diagnosis: Right lung hernia • trauma Symptoms: Chest pain • shortness of breath Medication: — Clinical Procedure: Chest tube • conservative management Specialty: Thoracic Surgery • Radiology • Trauma Surgery
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Affiliation(s)
- Walter J Morales Borrero
- Section of Diagnostic Radiology, School of Medicine, University of Puerto Rico (UPR) Medical Sciences Campus, San Juan, Puerto Rico
| | - José Madonado Vargas
- Section of Diagnostic Radiology, School of Medicine, University of Puerto Rico (UPR) Medical Sciences Campus, San Juan, Puerto Rico
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9
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Sinopoli J, Strong A, Kroh M, Allemang M, Raymond DP. Spontaneous Chest Wall Herniation in Centrally Obese Patients: A Single-Center Experience of a Rare Problem. Am Surg 2020; 87:222-227. [PMID: 32927964 DOI: 10.1177/0003134820950280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Spontaneous rib fractures, especially in association with chest wall herniation, represent an uncommon pathology. As such, there are little data analyzing approaches to treatment or regarding the success of intervention. The goal of this study was to analyze our cumulative experience with this unusual condition. METHODS A case series of 12 patients was gathered from a single institution based on outpatient visits between February 2015 and October 2018. Each chart was retrospectively reviewed with particular attention to age, gender, BMI, area of injury, and smoking history. Patients presented with complaints of dyspnea or pain related to rib fractures with or without intercostal neuralgia. Each of these patients was noted to have rib fractures with lung herniation either on imaging, outside hospital records, or physical exam. A thorough medical history was obtained with attempts to find common predisposing factors as well as data regarding any previous surgical intervention for their herniation. RESULTS Nine of the 12 patients reviewed had recent or prior surgical intervention. Every patient seen in the clinic with a spontaneous fracture and herniation incidentally had a BMI >30 and was therefore classified as obese. Additionally, every patient who had a recurrence after their first surgical attempt at repair had a BMI greater than or equal to 35. All 12 patients seen at our institution were males. The failure rate of operative intervention was 66%. CONCLUSIONS Obesity was a prevalent comorbidity in the patient population we reviewed. Given the role obesity plays in abdominal and hiatal hernia repair success rates, it should be considered that obesity is a significant contributor to chest wall herniation if rib fractures occur. With 66% chest wall repair failure, patient selection is critical in the success of surgical intervention. Perhaps additional patient optimization, especially weight loss, should be considered prior to surgery.
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Affiliation(s)
- Jillian Sinopoli
- Thoracic Department, Brigham & Women's Hospital, Boston, MA, USA
| | - Andrew Strong
- 443553 General Surgery Department, The Cleveland Clinic, Cleveland, OH, USA
| | - Matthew Kroh
- General and Bariatric Surgery, Digestive Disease Institute, The Cleveland Clinic, Abu Dhabi, UAE
| | - Matthew Allemang
- General Surgery Department, Minimally Invasive Surgery, The Cleveland Clinic, South Pointe Hospital, Warrensville Heights, OH, USA
| | - Daniel P Raymond
- General Thoracic Surgery, Center for Chest Wall Disease, The Cleveland Clinic, Cleveland, OH, USA
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10
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Walker BL, Boster J, Syed AS, Huprikar N, Sjulin T. Secondary Spontaneous Pneumothorax Mimicking Lung Herniation. Cureus 2020; 12:e9141. [PMID: 32789079 PMCID: PMC7417185 DOI: 10.7759/cureus.9141] [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] [Indexed: 11/05/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease (COPD) are at an increased risk for numerous pulmonary complications, including secondary spontaneous pneumothorax (SSP) and lung herniation. We describe the case of a 66-year-old female patient with severe COPD and previous lingula-sparing left upper lobectomy from adenocarcinoma who presented to the emergency department with a painful anterior chest wall mass that varied in size with respiration. This finding, in a patient with a prior history of an invasive thoracic procedure, is suggestive of lung herniation. Further investigation revealed an SSP mimicking the classic physical exam finding of a lung herniation. The patient was deemed a poor surgical candidate; therefore, talc pleurodesis was administered with resolution of the pneumothorax.
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Affiliation(s)
- Brandon L Walker
- Pulmonary and Critical Care, San Antonio Uniformed Services Health Education Consortium, San Antonio, USA
| | - Joshua Boster
- Internal Medicine, Brooke Army Medical Center, Fort Sam Houston, USA
| | - Azfar S Syed
- Internal Medicine, Madigan Army Medical Center, Joint Base Lewis-McCord, USA
| | - Nikhil Huprikar
- Pulmonary and Critical Care, Walter Reed National Military Medical Center, Bethesda, USA
| | - Tyson Sjulin
- Pulmonary and Critical Care, Brooke Army Medical Center, Fort Sam Houston, USA
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11
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Periosteal flap repair for traumatic lung hernia. An old technique revisited. J Trauma Acute Care Surg 2019; 86:551-553. [DOI: 10.1097/ta.0000000000002154] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Surgical vs. nonsurgical management of post-traumatic intercostal lung herniation in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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13
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Pérez Castro P, Undurraga Machicao F, Santolaya Cohen R, Berrios Silva R, Rivera F. Minimally invasive management of traumatic lung herniation. J Surg Case Rep 2017; 2017:rjx130. [PMID: 28852454 PMCID: PMC5569919 DOI: 10.1093/jscr/rjx130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 06/06/2017] [Accepted: 06/19/2017] [Indexed: 11/18/2022] Open
Abstract
Post-traumatic pulmonary hernia can occur immediately after thoracic trauma or it may also appear months or even years after the onset. We report a case of a seventeen year-old male patient with thoracic blunt trauma secondary to high energy bicycle accident. Chest CT shows moderate hemothorax and pneumothorax, displaced fracture of the fifth left rib, and protusion of pulmonary tissue through a chest wall defect. In the Emergency Room the patient presents with chest pain (7/10 in Visual Analog Scale) and respiratory distress. Video-assisted thoracic surgery approach was chosen. Hernia reduction, non-anatomic lingular resection and rib fracture external fixation using a titanium plate was performed. Traumatic pulmonary hernia is an uncommon complication of thoracic trauma which may constitute an emergency for the trauma or thoracic surgeon. The early management of this injury can be developed by minimally invasive approach with excellent results.
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Affiliation(s)
- Pablo Pérez Castro
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Division of Thoracic Surgery, Toronto General Hospital, University of Toronto,Toronto, Canada
| | - Felipe Undurraga Machicao
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Department of Surgery, Clinica Las Condes, Santiago, Chile
| | - Raimundo Santolaya Cohen
- Departament of Surgery, Universidad de Chile, Santiago, Chile.,Department of Surgery, Clínica Alemana,Universidad del Desarrollo, Santiago, Chile
| | - Raul Berrios Silva
- Department of Surgery, Clínica Alemana,Universidad del Desarrollo, Santiago, Chile
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14
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Traumatic Lung Herniation following Skateboard Fall. Case Rep Med 2016; 2016:9473906. [PMID: 27872645 PMCID: PMC5107222 DOI: 10.1155/2016/9473906] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 10/05/2016] [Indexed: 12/02/2022] Open
Abstract
Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT) scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues.
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15
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Abstract
Extrathoracic lung hernias can be congenital or acquired. Acquired hernias may be classified by etiology into traumatic, spontaneous, and pathologic. We present a case of a 40-year-old male with a history of bronchial asthma and a blunt chest trauma who presented complaining of sharp chest pain of acute onset that began after five consecutive days of vigorous coughing. Upon physical examination a well-demarcated deformity overlying the third intercostal space of the left upper anterior hemithorax was revealed. Thoracic CT scan showed that a portion of the anterior bronchopulmonary segment of the left upper lobe had herniated through a chest wall defect. The role of imaging, especially chest computed tomography with multiplanar image reconstructions and maximum (MIP) and minimum intensity projection (MinIP) reformats can clearly confirm the presence of the herniated lung, the hernial sac, the hernial orifice in the chest wall, and exclude possible complications such as lung tissue strangulation.
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Affiliation(s)
- Efstathios E Detorakis
- Department of Radiology, CT and MRI unit, Euromedic International, Heraklion, Crete, Greece ; Department of Radiology, CT unit, University hospital of Heraklion, Crete, Greece
| | - Emmanuel Androulidakis
- Department of Radiology, CT and MRI unit, Euromedic International, Heraklion, Crete, Greece
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16
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Marlow S, Campbell T, Davis A, Patel HR. Emergency ultrasound in the diagnosis of traumatic extrathoracic lung herniation. Am J Emerg Med 2013; 31:633.e1-2. [PMID: 23347717 DOI: 10.1016/j.ajem.2012.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 09/25/2012] [Indexed: 11/27/2022] Open
Affiliation(s)
- Stacey Marlow
- Department of Emergency Medicine, University of South Florida at Tampa General Hospital, Tampa, Florida, USA.
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