1
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El-Farra MH, Ali MW, Hasaniya N. Intercostal Hernia due to Forceful Coughing With Protrusion of the Lung. Am Surg 2023; 89:4869-4871. [PMID: 33847162 DOI: 10.1177/00031348211011087] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intercostal herniation is an abnormal protrusion of lung tissue through the boundaries of the thoracic cavity. It is commonly seen after chest trauma or thoracic surgery but rarely occurs spontaneously. We report a male patient who presented with an intercostal herniation after vigorous coughing for over 2 weeks. Treatment of post-coughing intercostal hernias is either conservative management or surgical intervention, which is dictated by the signs, symptoms, site, and presence of strangulation.
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Affiliation(s)
- Mohamed H El-Farra
- University of California Riverside School of Medicine, Riverside, CA, USA
| | - Mir Wasif Ali
- Department of Cardiothoracic Surgery, St. Bernardine Medical Center, San Bernardino, CA, USA
| | - Nahidh Hasaniya
- University of California Riverside School of Medicine, Riverside, CA, USA
- Department of Cardiothoracic Surgery, St. Bernardine Medical Center, San Bernardino, CA, USA
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2
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Bresler R, Rabadi T, Bellia K, Ogbuneke J, Harris S. Spontaneous intercostal herniation of lung and pleural fluid. Respir Med Case Rep 2023; 46:101925. [PMID: 37869609 PMCID: PMC10587599 DOI: 10.1016/j.rmcr.2023.101925] [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: 07/11/2023] [Accepted: 10/03/2023] [Indexed: 10/24/2023] Open
Abstract
Thoracic hernias are characterized by the protrusion of the thoracic contents outside their normal anatomical confines. This case involves a left pleural effusion secondary to a spontaneous lung intercostal hernia (SLIH) in a 52-year-old male. Imaging revealed herniated pleural fluid in the intercostal space. Intra-operatively, there was herniation of the lung parenchyma into an intercostal defect. Pleural effusion secondary to a SLIH is an indication for surgical repair.
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Affiliation(s)
- Richard Bresler
- Division of Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, MS, USA
| | - Thomas Rabadi
- Division of Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, MS, USA
| | - Kelley Bellia
- Division of Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, MS, USA
| | - Juvarez Ogbuneke
- Division of Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, MS, USA
| | - Samuel Harris
- Division of Internal Medicine, Baptist Memorial Hospital North Mississippi, Oxford, MS, USA
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3
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Vu PD, Blazek G, Cowan M, Philip K, Sambasivan A. Spontaneous pulmonary herniation in post-polio syndrome. J Ultrasound 2023:10.1007/s40477-023-00812-5. [PMID: 37566195 DOI: 10.1007/s40477-023-00812-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/17/2023] [Indexed: 08/12/2023] Open
Abstract
Pulmonary hernias are typically a result of trauma, thoracic operations, or congenital defects. Spontaneous lung hernias without a prior overt injury are notably rare. The presence of spontaneous lung hernias has not been reported in post-polio syndrome. Post-polio syndrome is a late sequela of poliomyelitis that usually presents 30-40 years after the initial illness with new presentations of progressive muscle weakness, abnormal muscle fatigue, muscle atrophy, and myalgia. This case report describes the presentation and imaging of a post-polio patient with an atraumatic, spontaneous lung hernia. A discussion on pulmonary hernias, diagnostic imaging, and management is also included.
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Affiliation(s)
- Peter D Vu
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA.
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA.
| | - Gregory Blazek
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
| | - Mogran Cowan
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
| | - Kemly Philip
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
| | - Ajai Sambasivan
- McGovern Medical School, The University of Texas Health Science Center, Houston, 6431 Fannin, Houston, TX, 77030, USA
- TIRR Memorial Hermann, 1333 Moursund St, Houston, TX, 77030, USA
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4
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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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5
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Avila-Castano K, Garzon-Siatoya WT, Gonzalez-Estrada A. Spontaneous Combined Lung and Bowel Herniation Due to Uncontrolled Asthma. Cureus 2023; 15:e34939. [PMID: 36938229 PMCID: PMC10017090 DOI: 10.7759/cureus.34939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 02/15/2023] Open
Abstract
Spontaneous lung and bowel hernias are infrequent structural defects secondary to conditions that usually follow bouts of excessive straining. These two conditions have been individually well documented in the literature; however, there are seldom reports of this combination of defects. Here, we describe the case of a 69-year-old man diagnosed with combined spontaneous lung and colon herniation following an episode of severe coughing due to uncontrolled asthma. Early recognition and prompt treatment should be warranted to prevent complications.
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Affiliation(s)
- Karol Avila-Castano
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, USA
| | - Wendy T Garzon-Siatoya
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, USA
| | - Alexei Gonzalez-Estrada
- Division of Pulmonary, Allergy, and Sleep Medicine, Department of Medicine, Mayo Clinic, Jacksonville, USA
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6
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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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7
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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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8
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Priyadarshi M, Meena VP, Ray A. Lung herniation post-removal of thoracostomy tube. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2022. [DOI: 10.1186/s43168-022-00126-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractA 30-year-old gentleman presented with complaints of fever, productive cough, and shortness of breath for 10 days. On presentation, he had a right intercostal drainage tube (ICD) in situ in view of chest radiograph findings where hydropneumothorax was suspected. He had a past history of pulmonary tuberculosis 3 years back for which he self-discontinued anti-tubercular therapy after 3 months. He was also diagnosed 2 years back with right pulmonary aspergilloma for which he was receiving anti-fungal therapy. Contrast-enhanced computed tomography (CECT) of the chest suggested right destroyed lung with multiple cavitations, ICD inserted in the right-sided lung cavity, and intracavitatory aspergilloma in the left lung. Hence, it was confirmed that the patient had a lung abscess with pus in a large cavity in the right lung which on chest radiograph had mimicked hydropneumothorax. The patient was subsequently diagnosed with a case of chronic cavitatory pulmonary aspergillosis, and the thoracostomy tube was removed. Post-tube removal, the patient developed lung herniation from the suture site which was confirmed on a CT scan for which the patient was successfully managed conservatively. Follow-up at 3 months did not reveal any evidence of lung herniation.
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9
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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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10
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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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11
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Kollipara VK, Lutchmedial S, Patel BB, Ie S, Rubio EE. Spontaneous posterior lung herniation: A case report and literature review. Lung India 2021; 38:481-485. [PMID: 34472529 PMCID: PMC8509158 DOI: 10.4103/lungindia.lungindia_540_20] [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
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.
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Affiliation(s)
- Venkateswara K Kollipara
- Department of Pulmonary and Critical Care, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Sanjiva Lutchmedial
- Department of Pulmonary and Critical Care, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Brijesh B Patel
- Department of Pulmonary and Critical Care, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Susanti Ie
- Department of Pulmonary and Critical Care, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
| | - Edmundo E Rubio
- Department of Pulmonary and Critical Care, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
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12
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Ferreira-Pozzi M, Erramouspe PJ, Folonier JC, Perez MP, González DG, Laurin EG. Anterior Lung Evisceration Following an Assault with Knife: A Case Report. Clin Pract Cases Emerg Med 2021; 5:335-340. [PMID: 34437042 PMCID: PMC8373191 DOI: 10.5811/cpcem.2021.4.51603] [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: 01/10/2021] [Accepted: 04/14/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction Evisceration of the lung is a rare consequence of open chest trauma that can be fatal. Evisceration of the lung refers to the protrusion of lung parenchyma through a defect of the thoracic wall, without parietal pleural or skin coverage. Case report A 20-year-old man was brought to the emergency department (ED) with left lung evisceration from stab wounds. The eviscerated lung was left in place, and the patient was not intubated in the ED. He was immediately taken to the operating room (OR) for intubation and surgical repair. Other significant injuries were ruled out, the eviscerated lung was retrieved, the chest wall defect was closed, and the patient recovered well. He was discharged after seven days in good condition. Conclusion The initial management of patients with lung evisceration is critical to prevent rapid decompensation and death. Appropriate ED airway management, lung retrieval in the OR, and thoracic wall repair is recommended for patients with lung evisceration.
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Affiliation(s)
- Martín Ferreira-Pozzi
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Pablo Joaquin Erramouspe
- Queensland University of Technology, Translational Research Institute, Brisbane, Queensland, Australia.,University of California Davis Health, Department of Emergency Medicine, Sacramento, California
| | - Juan Carlos Folonier
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Mauro Perdomo Perez
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Daniel González González
- University of the Republic, Maciel hospital, Department of Surgery, Clínica quirúrgica 3, Montevideo, Uruguay
| | - Erik G Laurin
- University of California Davis Health, Department of Emergency Medicine, Sacramento, California
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13
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Li F, Jiang H, Shen X, Yang W, Guo C, Wang Z, Xiao M, Cui L, Luo W, Kim BS, Chen Z, Huang AJW, Liu Q. Sneezing reflex is mediated by a peptidergic pathway from nose to brainstem. Cell 2021; 184:3762-3773.e10. [PMID: 34133943 PMCID: PMC8396370 DOI: 10.1016/j.cell.2021.05.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/05/2021] [Accepted: 05/12/2021] [Indexed: 12/24/2022]
Abstract
Sneezing is a vital respiratory reflex frequently associated with allergic rhinitis and viral respiratory infections. However, its neural circuit remains largely unknown. A sneeze-evoking region was discovered in both cat and human brainstems, corresponding anatomically to the central recipient zone of nasal sensory neurons. Therefore, we hypothesized that a neuronal population postsynaptic to nasal sensory neurons mediates sneezing in this region. By screening major presynaptic neurotransmitters/neuropeptides released by nasal sensory neurons, we found that neuromedin B (NMB) peptide is essential for signaling sneezing. Ablation of NMB-sensitive postsynaptic neurons in the sneeze-evoking region or deficiency in NMB receptor abolished the sneezing reflex. Remarkably, NMB-sensitive neurons further project to the caudal ventral respiratory group (cVRG). Chemical activation of NMB-sensitive neurons elicits action potentials in cVRG neurons and leads to sneezing behavior. Our study delineates a peptidergic pathway mediating sneezing, providing molecular insights into the sneezing reflex arc.
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Affiliation(s)
- Fengxian Li
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Haowu Jiang
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Xiaolei Shen
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Weishan Yang
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Changxiong Guo
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhiyao Wang
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Maolei Xiao
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Lian Cui
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Wenqin Luo
- Department of Neuroscience, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brian S Kim
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Zhoufeng Chen
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Developmental Biology, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Andrew J W Huang
- Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA
| | - Qin Liu
- Department of Anesthesiology, Center for the Study of Itch and Sensory Disorders, and Washington University Pain Center, Washington University School of Medicine, St. Louis, MO 63110, USA; Division of Dermatology, Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Ophthalmology & Visual Sciences, Washington University School of Medicine, St. Louis, MO 63110, USA; Department of Neuroscience, Washington University School of Medicine, St. Louis, MO 63110, USA.
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14
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Intrathoracic extrapleural lung herniation: A new type of lung hernia. North Clin Istanb 2021; 8:306. [PMID: 34222813 PMCID: PMC8240231 DOI: 10.14744/nci.2020.65881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 06/18/2020] [Indexed: 12/02/2022] Open
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15
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Ibrahim M, Linsmeier B. Lung herniation through the thoracic wall after persistent sneezing and coughing in an obesity and COPD Patient. J Surg Case Rep 2020; 2020:rjaa303. [PMID: 32913626 PMCID: PMC7474541 DOI: 10.1093/jscr/rjaa303] [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] [Received: 06/18/2020] [Revised: 07/13/2020] [Accepted: 07/16/2020] [Indexed: 11/27/2022] Open
Abstract
We present the case of a 61-year-old male patient with a known medical history of morbid obesity, chronic obstructive pulmonary disease and atrial fibrillation, who was receiving anticoagulation therapy with enoxaparin natrium prescribed by his family physician. The patient presented himself to the emergency department of our hospital with a complaint of severe pain in the right hemithorax, dyspnea, and diffuse cutaneous and subcutaneous haematoma in the inferior part of the right hemithoracic region. The patient underwent right-side video-assisted thoracic surgery on the second day to evacuate the haematothorax. Thoracic wall repair was achieved using a sandwich technique with a sublay reinforced with pericostal sutures and onlay insertion of bovine pericardium mesh.
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Affiliation(s)
- Mohammed Ibrahim
- Department of Cardiothoracic Surgery, Bayreuth Hospital, Bayreuth, Germany
| | - Bernd Linsmeier
- Department of Cardiothoracic Surgery, Bayreuth Hospital, Bayreuth, Germany
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16
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Schattner A. The Wide-Ranging Spectrum of Cough-Induced Complications and Patient Harm. Am J Med 2020; 133:544-551. [PMID: 32007456 DOI: 10.1016/j.amjmed.2019.12.044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 12/25/2019] [Accepted: 12/26/2019] [Indexed: 10/25/2022]
Abstract
Cough is one of the most common complaints encountered in every setting; however, complications associated with coughing have received relatively little attention. An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm. Prospective studies and prevalence data are conspicuously missing. Reported cough-induced pathology ranges from rare (the majority) to common and from trivial (eg, lightheadedness, subconjunctival hemorrhage) to severe and life-threatening (eg, cervical artery dissection, rupture of a normal spleen). Other seemingly benign entities may mask a serious underlying pathology (eg, cough headache, cough syncope). A substantial proportion of patients experience anxiety and insomnia, and their quality of life is affected. Thus, the wide spectrum of cough-induced pathology need to be recognized and considered in patients complaining of cough. Suppression of cough must not be neglected in patients at risk, and areas of uncertainty need to be clarified by future prospective studies.
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Affiliation(s)
- Ami Schattner
- The Faculty of Medicine, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
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17
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Dahlkemper CL, Greissinger WP. Spontaneous lung herniation after forceful coughing. Am J Emerg Med 2019; 38:851.e5-851.e6. [PMID: 31837904 DOI: 10.1016/j.ajem.2019.11.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 11/14/2019] [Indexed: 10/25/2022] Open
Abstract
Spontaneous lung herniation is a rare finding, most often the result of forceful coughing. Risk factors include obesity, male gender, tobacco use, and steroid use. Surgical repair is recommended due to increasing size of herniation and pain control. Life style modification, such as smoking cessation, is recommended in this patient population.
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Affiliation(s)
- Cynthia L Dahlkemper
- Emergency Department, Saint Vincent Hospital, 232 West 25th Street, Erie, PA 16544, USA.
| | - W Paul Greissinger
- Emergency Department, Saint Vincent Hospital, 232 West 25th Street, Erie, PA 16544, USA.
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18
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Cogen A, Van Schil P, Schurmans J. Conservative treatment of a posterior intercostal lung herniation: a case report. Acta Chir Belg 2019; 119:129-131. [PMID: 29298605 DOI: 10.1080/00015458.2017.1411553] [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: 10/18/2022]
Abstract
Introduction patients: A rare posterior intercostal lung herniation was diagnosed after a coughing spell by computed tomography and treated conservatively. Two years later, there were no specific complications or progression of the herniation. Methods, results and conclusions: There is no consensus on the indications for surgery and optimal treatment of this disorder.
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Affiliation(s)
| | - Paul Van Schil
- Department of Thoracic and Vasculair Surgery, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| | - Jef Schurmans
- Department of Cardiology, AZ Sint-Dimpna, Geel, Belgium
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19
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Abstract
BACKGROUND Sneezing is an almost universal daily phenomenon as a reflex to evacuate irritants from the nasal cavities. An autonomic-controlled buildup of intrathoracic pressure against a closed glottis followed by sudden release results in a burst of 1 kPa of air through the upper airway. Active intervention to limit a sneeze can be deleterious. Closure of the airway during a sneeze can result in over 20 times the airway pressures resulting in a variety of untoward events. This review summarizes all reported injuries that occurred as the result of a sneeze. OBJECTIVE The objective of this review is to summarize the risks of closed-airway sneezing and determine if there are any trends which can help understand such injuries. METHODS A comprehensive literature review was performed from 1948 to 2018 to identify all reports of sneeze-related injuries. Information was compiled from reports to gain insights into comorbidities and risk factors for sneeze injuries. RESULTS There were 52 unique reports of sneeze-related injuries in the literature that were categorized into 6 areas of injury: intrathoracic, laryngeal/pharyngeal, ocular/orbital, intracranial/neurological, otologic, and other. The mean age of subjects who suffered a sneeze injury was 40 years old (range: 15-84 years), with 81% being male gender. Thirty percent had a risk factor for injury of prior trauma (5) or respiratory compromise (5). CONCLUSION A variety of injuries can occur during a sneeze, especially when a closed-airway sneeze is attempted, and high Valsalva pressure is transmitted to the other systems. Men are more at risk for these injuries with the majority occurring in patients with no known risk factor. When triggered, a sneeze should be allowed to proceed without intervention to prevent associated injuries.
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Affiliation(s)
- Sean Setzen
- 1 Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Michael Platt
- 1 Department of Otolaryngology - Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
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20
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Scelfo C, Longo C, Aiello M, Bertorelli G, Crisafulli E, Chetta A. Pulmonary hernia: Case report and review of the literature. Respirol Case Rep 2018; 6:e00354. [PMID: 30302252 PMCID: PMC6167757 DOI: 10.1002/rcr2.354] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/14/2018] [Accepted: 07/01/2018] [Indexed: 11/29/2022] Open
Abstract
Pulmonary hernia (PH) is an uncommon condition. We report a case of PH secondary to thoracic surgical intervention. In addition to the rarity, the peculiarity of the case is given by the clinical course as it is characterized by a clinical latency before the onset. The patient showed risk factors such as obesity and poliomyelitis infection sequelae. We also reviewed the literature about this topic.
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Affiliation(s)
- Chiara Scelfo
- Department of Medical Specialties, Pneumology UnitArcispedale Santa Maria Nuova‐IRCCS, Azienda USL di Reggio EmiliaReggio EmiliaItaly
| | - Chiara Longo
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaParmaItaly
| | - Marina Aiello
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaParmaItaly
| | - Giuseppina Bertorelli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaParmaItaly
| | - Ernesto Crisafulli
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaParmaItaly
| | - Alfredo Chetta
- Department of Medicine and Surgery, Respiratory Disease and Lung Function UnitUniversity of ParmaParmaItaly
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21
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Hamid M, Ghani AR, Ullah W, Sarwar U, Patel R. Spontaneous Lung Herniation Leading to Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumopericardium. Cureus 2018; 10:e2861. [PMID: 30148014 PMCID: PMC6107042 DOI: 10.7759/cureus.2861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Spontaneous lung herniation is a rare phenomenon in which the lung parenchyma along with the pleural membranes protrudes outside their usual boundaries and can lead to a wide variety of complications. We are reporting a case of a middle-aged male who presented with chronic obstructive pulmonary disease (COPD) exacerbation with severe bouts of cough. Initial computed tomography (CT) chest was unrevealing, but two days later, he developed spontaneous lung herniation, which was initially managed conservatively, but later it progressed to pneumothorax, pneumomediastinum, with striking CT scan images showing extensive subcutaneous emphysema. Blowhole incisions were done on the anterior chest wall which led to ultimate recovery.
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Affiliation(s)
- Mohsin Hamid
- Internal Medicine, Abington Jefferson Health, Abington, USA
| | - Ali R Ghani
- Internal Medicine, Abington Jefferson Health, Abington, USA
| | - Waqas Ullah
- Internal Medicine, Abington Jefferson Health, Abington, USA
| | - Usman Sarwar
- Internal Medicine, Abington Jefferson Health, Abington, USA
| | - Rajesh Patel
- Pulmonary and Critical Care, Abington Jefferson Health, Abington, USA
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22
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Oostendorp SEV, Buijsman R, Zuidema WP. Cough-induced nonunion rib fractures and herniation: surgical repair and review. Asian Cardiovasc Thorac Ann 2018; 26:416-418. [DOI: 10.1177/0218492318772769] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present the case of a 57-year-old man who had suffered pain in the left hemithorax for a year, which started after a period of severe coughing during pneumonia. The pain was triggered by lying down. A computed tomography scan revealed two nonunion costal fractures. In the operating room, intercostal diastasis with pulmonary herniation was encountered in addition to the costal fractures. This report describes the technique used to reconstruct the thoracic wall with mesh and plate-osteosynthesis.
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Affiliation(s)
| | - Rene Buijsman
- Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Wietse P Zuidema
- Department of Trauma Surgery, VU University Medical Center, Amsterdam, The Netherlands
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23
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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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24
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Maeda T, Sato R, Luthe SK, Russell MC. Spontaneous Intercostal Lung Hernia. Am J Med 2017; 130:e399-e400. [PMID: 28460852 DOI: 10.1016/j.amjmed.2017.03.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Tetsuro Maeda
- Japanese National Physician Graduate Medical Education Program, United States Naval Hospital Okinawa, Chatan-cho, Nakagami-gun, Japan.
| | - Ryota Sato
- Japanese National Physician Graduate Medical Education Program, United States Naval Hospital Okinawa, Chatan-cho, Nakagami-gun, Japan
| | - Sarah Kyuragi Luthe
- Japanese National Physician Graduate Medical Education Program, United States Naval Hospital Okinawa, Chatan-cho, Nakagami-gun, Japan
| | - Matthew Craig Russell
- Department of Internal Medicine, United States Naval Hospital Okinawa, Chatan-cho, Nakagami-gun, Japan
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25
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Cherian SV, Ocazionez D, Estrada-Y-Martin RM. Spontaneous Lung Hernia Secondary to Persistent Cough: A Rare Entity. Arch Bronconeumol 2017; 54:101. [PMID: 28751132 DOI: 10.1016/j.arbres.2017.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/18/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Sujith V Cherian
- Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health-McGovern Medical School, TX, USA.
| | - Daniel Ocazionez
- Department of Diagnostic and Interventional Imaging, University of Texas Health-McGovern Medical School, Houston, TX, USA
| | - Rosa M Estrada-Y-Martin
- Divisions of Pulmonary, Critical Care and Sleep Medicine, University of Texas Health-McGovern Medical School, TX, USA
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26
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Abstract
We present a relatively rare clinical presentation of herniation of lung parenchyma. In our case, the patient suffered multiple rib fractures, with an intercostal herniation of lung tissue after a trauma. We opted for a conservative treatment, given the clinical presentation, and the absence of incarceration or strangulation of the pulmonary tissue. In the absence of clear guidelines for this rare presentation, current treatment can be conservative or surgical, depending on the clinical presentation.
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27
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Abu Tair A, Kull C, Rosenberg R, Mechera R. Lateral lung hernia following a low-energy trauma without bony injuries: A case report. Int J Surg Case Rep 2016; 24:54-6. [PMID: 27180321 PMCID: PMC4872471 DOI: 10.1016/j.ijscr.2016.05.005] [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: 03/23/2016] [Revised: 04/18/2016] [Accepted: 05/02/2016] [Indexed: 12/03/2022] Open
Abstract
Lateral lung hernias are rare and can also occur following low-energy traumas. For thoracic pain with appropriate history and external signs of a trauma a CT scan should be considered at an early stage. Surgical management is recommended for persistent symptoms and large defect size.
Introduction Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax. Presentation of case We present the case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall. Chest X-ray suggested a pneumonia and subsequently the patient was treated with antibiotics. Due to persistent symptoms after 12 days a CT-scan was performed which showed an intercostal lung herniation without fractures. Surgeons were consulted and recommended an operative intervention. Intraoperatively the herniation could be confirmed and necrotic lung tissue was resected. The patient recovered well and was discharged after 10 days in good general condition. Discussion Herniation of lung tissue occurs as a result of injured intercostal muscles in a sudden increase of intrathoracic pressure. Especially lateral herniation is rare because of the additional lateral reinforcement of the thoracic wall by the Serratus muscle. While a conservative approach is possible in asymptomatic hernias and small defect size, surgical intervention is indicated for larger hernias, possible incarceration of lung tissue with resulting infarction and symptoms like chronic pain or respiratory failure. Conclusion For an adequate differential diagnosis of thoracic pain with a history and external signs of a trauma, a CT imaging should be evaluated at an early stage even after a low-energy trauma. An operation is indicated for large defect size and persistent symptoms.
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Affiliation(s)
- Assim Abu Tair
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland.
| | - Christof Kull
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Robert Rosenberg
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland
| | - Robert Mechera
- Department of Surgery, Cantonal Hospital of Liestal, Rheinstrasse 26, 4410 Liestal, Switzerland; Department of Surgery, University Hospital of Basel, Spitalstrasse 21, 4031 Basel, Switzerland
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28
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Wani AS, Kalamkar P, Alhassan S, Farrell MJ. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma. Oxf Med Case Reports 2015; 2015:378-81. [PMID: 26719812 PMCID: PMC4689984 DOI: 10.1093/omcr/omv069] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 11/02/2015] [Accepted: 11/24/2015] [Indexed: 11/16/2022] Open
Abstract
Lung herniation has been defined as a protrusion of lung tissue through its bounding structure. We present a case of spontaneous intercostal lung herniation following bouts of cough, which was complicated by multiple rib fractures, in which we had to adopt a non-surgical approach due to the clinical circumstance. Its understanding in the field of internal medicine is important as appropriate therapeutic judgment, and long-term follow-up is essential for full recovery.
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Affiliation(s)
- Adil S Wani
- Division of Internal Medicine , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
| | - Prachi Kalamkar
- Division of Internal Medicine , Conemaugh Memorial Medical Centre , Johnstown, PA , USA
| | - Sulaiman Alhassan
- Division of Pulmonary Critical Care , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
| | - Michael J Farrell
- Division of Internal Medicine , Allegheny General Hospital, Allegheny Health Network , Pittsburgh, PA , USA
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29
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Genbrugge E, Kichari JR. Cough-induced intercostal lung herniation. JOURNAL OF ACUTE DISEASE 2015. [DOI: 10.1016/s2221-6189(15)30031-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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30
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Kara HV, Javidfar J, D’Amico TA. Spontaneous Herniation of the Lung and Diaphragm Treated With Surgical Repair. Ann Thorac Surg 2015; 99:1821-3. [DOI: 10.1016/j.athoracsur.2014.06.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/09/2014] [Accepted: 06/11/2014] [Indexed: 11/16/2022]
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31
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Aguir S, Boddaert G, Weber G, Hornez E, Pons F. [Lung hernia provoked by a cough fit]. REVUE DE PNEUMOLOGIE CLINIQUE 2015; 71:60-63. [PMID: 25687819 DOI: 10.1016/j.pneumo.2014.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 09/30/2014] [Accepted: 11/08/2014] [Indexed: 06/04/2023]
Abstract
Lung hernias are rare and their pathogenesis is few described. They are defined as the protrusion of lung parenchyma through the chest wall: intercostal space, inter-costo-clavicular, supra-clavicular or diaphragmatic hiatus. Lung hernias are classically divided into congenital and acquired hernias. Those are usually post-traumatic or post-surgical but can be provoked by cough. Clinical diagnosis is often evident but is confirmed by chest radiograph and especially computed tomography. Major risks are lung incarceration and necrosis but also ventilatory distress due to paradoxical respiration, in case of large defect. Treatment is first and foremost surgical but debated and should consider the localization, the size, the length of evolution and the possible infectious context. We report the case of a right basi-thoracic lung hernia induced by a cough fit, in a patient with chronic bronchitis.
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Affiliation(s)
- S Aguir
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - G Boddaert
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France.
| | - G Weber
- Service d'imagerie médicale, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - E Hornez
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
| | - F Pons
- Service de chirurgie thoracique et vasculaire, hôpital d'instruction des armées Percy, 101, avenue Henri-Barbusse, 92140 Clamart, France
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33
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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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34
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Lakshminarayana UB, Cowen M, Kastelik JA, Morjaria JB. Intermittent swelling in the chest; a case of spontaneous intermittent lung herniation. BMJ Case Rep 2013; 2013:bcr-2013-201380. [PMID: 24177461 DOI: 10.1136/bcr-2013-201380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Herniation of the lung is uncommon and occurs due to protrusion of the lung beyond the confines of the thoracic cavity through an abnormal opening in the chest wall. Any condition associated with raised intrathoracic pressure or that which weakens the thoracic wall may result in lung herniation. We present a case of spontaneous lung herniation which was managed successfully by minimally invasive thoracic surgery.
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35
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Choe CH, Kahler JJ. Herniation of the lung: a case report. J Emerg Med 2013; 46:28-30. [PMID: 24120349 DOI: 10.1016/j.jemermed.2013.08.040] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Revised: 04/04/2013] [Accepted: 08/15/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. OBJECTIVES To discuss the presentation of a patient found to have a spontaneous lung and bowel herniation, and to review the literature regarding these entities. CASE REPORT A 61-year old gentleman with a history of chronic obstructive pulmonary disease and previous long-standing smoking history presented with complaints of right-sided chest pain and cough. He was found to have a spontaneous right lateral lung herniation. This was managed expectantly, but the patient subsequently developed spontaneous right-sided diaphragmatic rupture and herniation of bowel contents through the chest wall. CONCLUSION To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.
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Affiliation(s)
- Carol H Choe
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
| | - John J Kahler
- Department of Emergency Medicine, University of Michigan, Ann Arbor, Michigan
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36
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Karangizi AHK, Renaud SJ, Rao JN, Chetty G. Diaphragmatic and intercostal muscle tear after an episode of violent sneezing: spontaneous diaphragmatic injury. Ann Thorac Surg 2013; 96:301-2. [PMID: 23816080 DOI: 10.1016/j.athoracsur.2012.11.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/28/2012] [Accepted: 11/12/2012] [Indexed: 11/26/2022]
Abstract
Spontaneous diaphragmatic injuries are rare, accounting for approximately 1% of all diaphragmatic injuries. We report a case of a 69-year-old male with a concurrent lower respiratory tract infection who sustained diaphragmatic and intercostal muscle injuries after an episode of violent sneezing. To our knowledge, this is the first reported case of spontaneous diaphragmatic injury after sneezing.
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37
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Chmielik LP, Zawadzka-Głos L, Brzewski M, Ryczer T, Roik D, Koziołek R, Dębska M. Neck tumour - lung hernia in a 10-year-old girl - diagnostic difficulties. Int J Pediatr Otorhinolaryngol 2012; 76:593-5. [PMID: 22297211 DOI: 10.1016/j.ijporl.2011.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 12/29/2011] [Accepted: 12/30/2011] [Indexed: 11/26/2022]
Abstract
Spontaneous hernias of the pleural cupola are extremely rare tumours in the neck area. The most common tumours in children are lymph node abnormalities, and cysts that are remnants of the branchial arches. Due to diagnostic and therapeutic difficulties, we would like to present the case of a 10-year-old girl, with a neck tumour that was observed during coughing and was accompanied by dyspnea. The girl was admitted to the Paediatric Hospital of Warsaw Medical University. Finally, the neck tumour was diagnosed as a hernia of the pleural cupola, which was subsequently treated surgically. In a review of the literature we found two case reports of similar disorders that appeared spontaneously. All cases of neck tumours in children require very precise radiological diagnostic investigation. Spontaneous lung hernia is an extremely rare cause of neck tumours, which is treated surgically if it becomes symptomatic.
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Affiliation(s)
- L P Chmielik
- Department of Paediatric Otorhinolaryngology, Medical University, Warsaw, Poland.
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38
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Kaliyadan A, Kebede A, Ali T, Karchevsky M, Vasseur B, Patel N. Spontaneous Transient Lateral Thoracic Lung Herniation Resulting in Systemic Inflammatory Response Syndrome (SIRS) and Subsequent Contralateral Lung Injury. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2011; 4:39-42. [PMID: 22084612 PMCID: PMC3201100 DOI: 10.4137/ccrep.s7002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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.
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39
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Marsico GA, Boasquevisque CHR, Loureiro GL, Marques RF, Clemente AM. [Traumatic lung hernia]. Rev Col Bras Cir 2011; 38:77-8. [PMID: 21537748 DOI: 10.1590/s0100-69912011000100014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2006] [Accepted: 02/10/2007] [Indexed: 11/21/2022] Open
Abstract
Traumatic lung herniation is an unusual clinical problem. We present a case of a large left post-traumatic lung hernia on the left, anterior, second intercostal space following blunt chest trauma. An important factor in the etiology of these lesions is the relative lack of muscular support of the anterior part of the chest. This report describes the diagnosis and management of a post-traumatic lung hernia.
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Habib A, Elsayed H, Dhanji ARA, Wood A. Spontaneous combined lung and bowel hernia following an episode of acute bronchitis. Interact Cardiovasc Thorac Surg 2010; 10:1042-3. [DOI: 10.1510/icvts.2009.231845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Vincze K, Zádori P, Magyaródi Z, Horváth G. [Spontaneous thoracic hernias--report of two cases, surgically treated]. Magy Seb 2010; 63:80-83. [PMID: 20400399 DOI: 10.1556/maseb.63.2010.2.5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The authors present two cases of atraumatic (spontaneous) thoracic lung hernias, which are extreme rarities in the international literature, too. Risk factors and clinical pictures discussed and operative treatments are demonstrated. The spontaneous thoracic (intercostal) hernias were provoked by intractable cough caused by chronic obstructive pulmonary disease (COPD) in both cases. Multi-slice spiral CT (MSCT) scan as well as the secondary 3D 'volume rendering' (VRT) reconstructions unequivocally suggested this rare condition. Provided with the exact diagnosis, the surgical correction of the thoracic wall resulted in full recovery of the two patients. Finally, the authors briefly discuss data of thoracic hernias published in the Hungarian and the international literature. They conclude that the awareness of this extremely rare condition is important due to the high prevalence of COPD as a risk factor. Diagnostic imaging demonstrated can provide significant help in the correct diagnosis of similar cases.
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Affiliation(s)
- Károly Vincze
- Kaposi Mór Oktató Kórház Altalános-, Mellkas- és Ersebészeti Osztály Kaposvár
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Chang JL, Maritato K, Ryan KA. What is your diagnosis? Intermittent cranial lung lobe herniation into the cervical region. J Am Vet Med Assoc 2010; 236:627-8. [PMID: 20225970 DOI: 10.2460/javma.236.6.627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Jennifer L Chang
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
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Jastrow KM, Chu D, Jaroszewski D, Huh J, Bakaeen F. Posterior lung herniation after a coughing spell: a case report. CASES JOURNAL 2009; 2:86. [PMID: 19171045 PMCID: PMC2642787 DOI: 10.1186/1757-1626-2-86] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/26/2009] [Indexed: 12/02/2022]
Abstract
Lung hernias are rare, occurring most commonly after trauma or surgery. Spontaneous lung hernias are even rarer and have only been reported as occurring anteriorly. We present a 72-year-old male who developed a spontaneous posterior lung hernia after a severe coughing episode. We describe the evaluation and surgical management of this unusual condition and provide a brief review of the literature.
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Affiliation(s)
- Kenneth M Jastrow
- Baylor College of Medicine and the Michael E, DeBakey Veterans Affairs Medical Center, 2002 Holcombe Blvd, Houston, TX 77030, USA.
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Sulaiman A, Cottin V, De Souza Neto EP, Orsini A, Cordier JF, Gamondes JP, Tronc F. Cough-induced intercostal lung herniation requiring surgery: Report of a case. Surg Today 2007; 36:978-80. [PMID: 17072718 DOI: 10.1007/s00595-006-3284-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2005] [Accepted: 05/16/2006] [Indexed: 10/24/2022]
Abstract
Lung herniation is a rare event defined by protrusion of the lung through an abnormal weakness in the thoracic wall. We report a case of spontaneous intercostal pulmonary herniation, which occurred as a result of vigorous coughing. We repaired the herniation by approximating the ribs with heavy stitches. The mechanism of intercostal muscle disruption, and the etiology and treatment of lung herniations, are discussed.
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Affiliation(s)
- Abdulrazzaq Sulaiman
- Department of Thoracic Surgery, Hôpital Louis Pradel, 28, Avenue du Doyen Lépine, 69677, Bron Cedex, France
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Szentkereszty Z, Boros M, Sápy P, Kiss SS. Surgical treatment of intercostal hernia with implantation of polypropylene mesh. Hernia 2006; 10:354-6. [PMID: 16736104 DOI: 10.1007/s10029-005-0035-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2005] [Accepted: 07/26/2005] [Indexed: 11/26/2022]
Abstract
The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon, Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence. In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation. Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias. Recurrence is rare in those patients treated with this method.
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Affiliation(s)
- Z Szentkereszty
- 2nd Department of Surgery, Medical and Health Science Center, University of Debrecen, Móricz Zs. Krt. 22, 4004 Debrecen, Hungary.
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Abstract
Lung herniation is uncommon and has been defined as the protrusion of pulmonary tissue and pleural membranes through defects of the thoracic wall. In combination with rib fractures caused by single massive coughing fit, spontaneous lung herniation has previously been reported only three times. To our knowledge, in combination with multiple rib fractures and flail chest, as in the case presented, it has never been reported. Large lung hernias should be treated with prosthetic patches because of unlikely spontaneous recovery and the risk of incarceration. In our case, an anterolateral thoracotomy was performed. After resection of the herniated pleural membrane, a 30 x 30-cm polypropylene mesh was fixed to the diaphragm and with nonresorbable pericostal sutures to the thoracic wall. With this procedure, the loss in stability caused by the ruptured anterior intercostal muscular system could be restored. The postoperative course was uneventful, and the patient was dismissed on day 12.
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Affiliation(s)
- B Schnüriger
- Chirurgische Klinik, Zuger Kantonsspital, Schweiz.
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Affiliation(s)
- Maneesh Gupta
- Department of Molecular and Medical Genetics, Oregon Health & Science University, Portland, OR 97239, USA.
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Coleman MG, Warman CG, Robson MC. Dynamic Cervical Lung Hernia in a Dog with Chronic Airway Disease. J Vet Intern Med 2005. [DOI: 10.1111/j.1939-1676.2005.tb02666.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
The authors report a case of a lateral chest wall lung hernia, which was presumably congenital. Lung herniations are extremely rare, and congenital herniation of the lung through an apparently intact thoracic cage has not yet been reported. The hernia was repaired by the interposition of a polypropylene mesh. The literature of this rare condition is briefly reviewed.
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Abstract
BACKGROUND Lung hernia is uncommon and methods of management vary. During the past 17 years, we have seen 8 patients with this condition. METHODS Between 1984 and 2000, 8 patients with lung hernias were seen on our service. Three hernias were caused by a thoracic operation, one was due to chronic cough, and in four, the hernia was congenital, with delayed presentation. RESULTS Three patients had minimal symptoms and were not operated on. Closure of chest wall in the other patients was accomplished by suture approximation of ribs in 4 patients and by polypropylene mesh in 1 patient. There were no recurrences, and these patients remain asymptomatic. CONCLUSIONS Intercostal hernias are usually symptomatic and should be treated by operative closure. In supraclavicular hernias, the symptoms are usually minimal and complications are unlikely. These hernias can be left untreated, but the patients should be followed.
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Affiliation(s)
- Dov Weissberg
- Department of Thoracic Surgery, E. Wolfson Medical Center, Holon, Israel.
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