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Clinical Summary

Lung herniation is a rare cause of chest pain and dyspnea in which the lung parenchyma protrudes through a defect in the thoracic wall. It typically occurs due to a preexisting weakness in the thoracic wall combined with an acute rise in intrathoracic pressure such as during a cough, sneeze, or Valsalva. Obesity, steroid use, prior injury, and surgery are risk factors for herniation. Symptoms include chest pain with cough, local pain, and swelling in the area of the herniation, which may vary in size during respirations. The deformity is typically reducible.

Management and Disposition

Diagnosis is confirmed with chest computed tomography (CT). Thoracic surgery consultation timing depends on the severity of symptoms or presence of strangulation, but most cases are nonemergent, and routine referral is adequate. Conservative treatment includes compressive pads, corsets, weight loss, and treatment of underlying lung disease.

Pearls

  1. Pneumothorax is often associated with coughing with a closed glottis during deep inhalation (including marijuana).

  2. Rupture of the intercostal musculature and lung herniation are lesser known complications of increased intrathoracic pressure.

FIGURE 7.9

Lung Herniation. Chest wall deformity during inspiration in a patient with lung herniation after remote robotic coronary artery bypass grafting. (Photo contributor: Harry Stark, MD.)

FIGURE 7.10

Lung Herniation. Chest wall deformity during expiration in a patient with lung herniation after remote robotic coronary artery bypass grafting. (Photo contributor: Harry Stark, MD.)

FIGURE 7.11

Lung Herniation and Pneumothorax on CT of Chest. Chest wall defect and pneumothorax of the same patient. (Photo contributor: Harry Stark, MD.)

FIGURE 7.12

Lung Herniation on CT of Chest. Spontaneous lung herniation after a vigorous cough while using marijuana in a different patient than above. Chest CT reveals lung herniation through a chest wall defect. (Photo contributor: Kevin Barlotta, MD.)

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