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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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Berry B, Ghazaleh D, Matar R, Beran A, Risser J, Warren BJ, Ghannam M. Acquired intercostal lung herniation: conservative management may lead to continuation of symptoms and other adverse consequence. Gen Thorac Cardiovasc Surg 2019; 68:403-407. [PMID: 31187412 DOI: 10.1007/s11748-019-01156-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Accepted: 06/01/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND It is quite rare for lung to herniate between a patient's ribs, most often seen after surgery; it is, however, also rarely seen in other situations, notably during coughing fits situations such as coughing spells. There is minor controversy in the literature regarding management, namely, a question of whether to manage conservatively or with surgical correction, since this is such a rare entity physicians, may face difficulty in knowing how to proceed. Here, we provide evidence supporting acquired lung herniation management to be repaired surgically, and early, while at the same time medically optimizing the patient's risk factors for further herniation events or intercostal muscle tears. PRESENTATION We report a 79-year-old man who suffered a right-sided lung herniation as a result of vigorous coughing, he initially was managed conservatively, and symptoms worsened but then underwent surgical repair which was associated with a suitable outcome. CONCLUSION Lung herniation will may resolve on its own and prompt correction should be considered instead of conservative management. We recommend early surgical repair for all intercostal lung herniations, even if they are asymptomatic, to prevent complications or extension of the defect into the abdominal wall. Surgery may offer the best results, with low morbidity and no mortality reported to date.
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Affiliation(s)
- Brent Berry
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA
| | - Dana Ghazaleh
- An-Najah National University, Nablus, Palestine.,University of Minnesota, Minneapolis, MN, USA
| | - Reem Matar
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Azizullah Beran
- Department of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - James Risser
- Department of Hospital Medicine/HealthPartners, St. Paul, USA
| | - Bryan J Warren
- Department of Hospital Medicine/HealthPartners, St. Paul, USA
| | - Malik Ghannam
- Department of Neurology, University of Minnesota, Minneapolis, MN, USA.
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Galetta D, Spaggiari L. Beyond the boundaries: Surgical repair of apical parietal pleural hernia. J Thorac Cardiovasc Surg 2018; 157:e189-e190. [PMID: 30553596 DOI: 10.1016/j.jtcvs.2018.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Domenico Galetta
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology-DIPO, University of Milan, Milan, Italy
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Chaturvedi A, Rajiah P, Croake A, Saboo S, Chaturvedi A. Imaging of thoracic hernias: types and complications. Insights Imaging 2018; 9:989-1005. [PMID: 30484078 PMCID: PMC6269341 DOI: 10.1007/s13244-018-0670-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/06/2018] [Accepted: 10/18/2018] [Indexed: 12/23/2022] Open
Abstract
Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. Multiple imaging modalities are available to evaluate thoracic hernias. Radiographs usually offer the first clue to the diagnosis. Upper gastrointestinal radiography can identify bowel herniation and associated complications. CT and occasionally MR can be useful for further evaluation of these abnormalities, accurately identifying the type of hernia, its contents, associated complications, and provide a roadmap for surgical planning. In this article, we review the different types of thoracic hernias and the role of imaging in the evaluation of these hernias. TEACHING POINTS: • Protrusion of lung contents beyond the anatomic confines of the thorax constitutes a hernia. • Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. • Multiple imaging modalities are available to evaluate thoracic hernias. • CT is the imaging modality of choice for identifying thoracic hernias and their complications. • Imaging can provide a roadmap for surgical planning.
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Affiliation(s)
- Abhishek Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA.
| | - Prabhakar Rajiah
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alexender Croake
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
| | - Sachin Saboo
- Radiology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Apeksha Chaturvedi
- Imaging Science, University of Rochester Medical Center, 601, Elmwood Avenue, Rochester, NY, 14642, USA
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A case of lung herniation with hemothorax in a patient with asthma and atrial fibrillation. Respir Med Case Rep 2018; 25:267-269. [PMID: 30364655 PMCID: PMC6197505 DOI: 10.1016/j.rmcr.2018.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 09/25/2018] [Accepted: 09/30/2018] [Indexed: 12/04/2022] Open
Abstract
A 83 years old man was admitted to acute medical unit for mild asthma exacerbation. He also had atrial fibrillation and was on dabigatran. A mass on left upper chest wall was incidentally found. There were bruises over left posterolateral aspect of chest wall. Chest X-ray showed left pleural effusion. Diagnostic tap yielded blood-stained fluid. Computer tomography showed left lung herniation. Cardiothoracic surgery team unit was consulted. Reduction of lung herniation and patch repair of chest wall defect was done.
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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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Talbot BS, Gange CP, Chaturvedi A, Klionsky N, Hobbs SK, Chaturvedi A. Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment. Radiographics 2017; 37:628-651. [DOI: 10.1148/rg.2017160100] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Brett S. Talbot
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Christopher P. Gange
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Apeksha Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Nina Klionsky
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Susan K. Hobbs
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
| | - Abhishek Chaturvedi
- From the School of Medicine and Dentistry, University of Rochester Medical Center, 601 Elmwood Ave, Box 648, Rochester, NY 14642
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Puah SH, Tan Pei Sze C, Abisheganaden J. Lung herniation after positive pressure ventilation. Respir Med Case Rep 2016; 20:61-63. [PMID: 28053853 PMCID: PMC5198735 DOI: 10.1016/j.rmcr.2016.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 12/16/2016] [Indexed: 11/02/2022] Open
Abstract
Lung herniation is a rare condition which has only been mainly published as case reports in the literature. Although its description has been around since 1845, not much is still known about it. More often seen after trauma or as a surgical complication post thoracic surgery, it's management usually depends on its etiology and varies between individuals. We report a case of lung herniation after positive pressure ventilation from a previous thoracotomy site. To our knowledge, this is the first report where the lung herniation was precipitated by mechanical ventilation.
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Affiliation(s)
- Ser Hon Puah
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - Carmen Tan Pei Sze
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
| | - John Abisheganaden
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, Singapore 308433, Singapore
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Lehmann CJ, Daftary AS, Machogu EM. Apical Lung Herniation Associated with Continuous Positive Airway Pressure in a 4-Year-Old Girl. J Clin Sleep Med 2016; 12:1565-1566. [PMID: 27397657 DOI: 10.5664/jcsm.6292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 05/31/2016] [Indexed: 11/13/2022]
Abstract
ABSTRACT We report a case of apical lung herniation through the superior thoracic aperture of an obese child using nocturnal CPAP. Lung herniation has been described in association with congenital thoracic abnormalities and elevated intra-thoracic pressure, such as trauma. This patient was hospitalized with community acquired pneumonia and required nocturnal CPAP for treatment of concurrent obstructive sleep apnea. Her lung hernia was discovered incidentally on routine follow-up chest radiography and resolved with cessation of CPAP treatment. Lung herniation in association with the use of continuous positive airway pressure (CPAP) has not been previously described.
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Affiliation(s)
- Christopher J Lehmann
- Indiana University School of Medicine, Internal Medicine and Pediatrics Residency, Indianapolis, IN
| | - Ameet S Daftary
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
| | - Evans M Machogu
- Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, IN
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Mohebbi MR, Bausano BJ, Vollstedt KA. Man With a Bump on the Chest. Ann Emerg Med 2016; 68:e53-4. [PMID: 27451309 DOI: 10.1016/j.annemergmed.2016.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Mohammad R Mohebbi
- Department of Emergency Medicine, University of Missouri-Columbia, Columbia, MO
| | - Brian J Bausano
- Department of Emergency Medicine, University of Missouri-Columbia, Columbia, MO
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Akkas Y, Peri NG, Kocer B, Kaplan T. Repair of lung herniation with titanium prosthetic ribs and Prolene mesh. Asian Cardiovasc Thorac Ann 2015; 24:280-2. [PMID: 26612961 DOI: 10.1177/0218492315619509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We present a rare case of intercostal lung herniation due to blunt trauma. A 40-year-old man was admitted to our hospital with lung herniation due to falling off a donkey. Computed tomography demonstrated a fracture of the 8th left rib, a comminuted fracture of the 9th rib, and lung herniation into the 8th intercostal space. The herniation was repaired using a titanium prosthetic rib, a rib plate, and Prolene mesh via a thoracotomy.
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Affiliation(s)
- Yucel Akkas
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Neslihan Gülay Peri
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Bulent Kocer
- Department of Thoracic Surgery, Ankara Numune Research and Training Hospital, Ankara, Turkey
| | - Tevfik Kaplan
- Department of Thoracic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
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Abstract
The abrupt onset of respiratory failure secondary to asthma, known as acute asphyxial asthma (AAA) in adults, is uncommonly reported in children. Here, we report a case of a child with the acute onset of respiratory failure consistent with AAA complicated by the finding of a neck mass during resuscitation. This 11-year-old boy with a history of asthma initially presented in respiratory failure with altered mental status after the complaint of difficulty in breathing minutes before collapsing at home. Initially, his respiratory failure was thought to be secondary to status asthmaticus, and treatment was initiated accordingly. However, a neck mass noted during the resuscitation was cause for concern, and other etiologies for his respiratory failure were considered, including an airway obstructing neck mass. After pediatric surgery and anesthesia consultation for intubation and possible tracheostomy placement, general anesthesia was induced in the operating room with an inhaled anesthetic, with prompt resolution of the bronchspasm and decompression of the neck mass. Review of the imaging and clinical course ultimately yielded a diagnosis of cervical lung herniation as the etiology of his neck mass. We report this case of AAA and cervical lung herniation and a review of the literature of these 2 uncommon phenomena in children.
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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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Prasad S, Rao K, Belle J, Rau NR. An unusual cause for neck swelling: apical lung hernia. BMJ Case Rep 2014; 2014:bcr-2013-202952. [PMID: 24515238 DOI: 10.1136/bcr-2013-202952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Srikanth Prasad
- Department of Internal Medicine, Kasturba Medical College, Manipal, Karnataka, India
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Intercostal lung hernia: radiographic and MDCT findings. Clin Radiol 2013; 68:e412-7. [PMID: 23522483 DOI: 10.1016/j.crad.2012.11.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Revised: 11/03/2012] [Accepted: 11/12/2012] [Indexed: 11/23/2022]
Abstract
Lung hernia, defined as protrusion of pulmonary tissue beyond the normal confines of the thoracic cage, is an unusual clinical entity. We describe radiographic and MDCT findings in a series of six cases. The diagnostic sign of intercostal lung hernia apparent on a chest radiograph and cross-sectional imaging is the detection of lung parenchyma or intra-thoracic contents beyond the rib cage. Multidetector computed tomography (MDCT) allows a detailed study of the underlying anatomy and is helpful in planning further management.
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Choi YS, Son YJ, Bae SY, Min KS, Cho YK, Choi WY, Choi YY, Ma JS, Hwang TJ. Congenital hernia of the lung through the azygoesophageal recess. KOREAN JOURNAL OF PEDIATRICS 2008. [DOI: 10.3345/kjp.2008.51.10.1123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Young Seok Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Young Jun Son
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Si Young Bae
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Kyung Sun Min
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Young Kuk Cho
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Woo Yeon Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Young Youn Choi
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Jae Sook Ma
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
| | - Tai Ju Hwang
- Department of Pediatrics, Chonnam National University Medical School, Gwangju, Korea
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Petteruti F, Pepino P, De Luca G, Griffo S, Di Tommaso L, Stassano P. An unusual case of lateral pulmonary hernia. J Thorac Cardiovasc Surg 2006; 132:189-90. [PMID: 16798336 DOI: 10.1016/j.jtcvs.2006.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2006] [Accepted: 03/15/2006] [Indexed: 10/24/2022]
Affiliation(s)
- Francesco Petteruti
- Cardiothoracic Surgery Unit, Clinica Pineta Grande Castelvolturno, CE, Naples, Italy.
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Rice D, Bikkasani N, Espada R, Mattox K, Wall M. Seat belt-related chondrosternal disruption with lung herniation. Ann Thorac Surg 2002; 73:1950-1. [PMID: 12078797 DOI: 10.1016/s0003-4975(01)03506-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A case of blunt chest trauma resulting in anterior chondrosternal separation with right lung herniation and hemothorax is presented. The injury is related to the use of a seat belt restraint. The patient underwent surgical repair with polytetrafluoroethylene chest wall reconstruction. Postoperative recovery was complicated by respiratory insufficiency due to underlying pulmonary contusion and multiple rib fractures.
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Affiliation(s)
- David Rice
- Division of Cardiothoracic Surgery, Ben Taub General Hospital, Houston, Texas, USA.
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Hernia pulmonar traumática por asta de toro. Cir Esp 2001. [DOI: 10.1016/s0009-739x(01)71883-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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