intercostal lung hernia

Transkostale

Lungenhernie zwischen 9. und 10. Rippe rechts bei erweitertem Abstand zwischen diesen, mutmaßlich als Restzustand eines älteren Traumas (anamnestisch nicht zu klären).

Wikipedia • CC BY-SA 4.0

Infant who

had undergone emergency thoracotomy for cardiac massage during a cardiac arrest 6 months before and now has a lump under the left arm. CXR AP in inspiration (above) shows the left 5th intercostal space at the side of the previous thoracotomy to be deformed. CXR AP in expiration (below) shows interval development of a cystic structure in the soft tissues of the left chest wall.The diagnosis was pulmonary herniation through the left 5th intercostal space secondary to incorrectly repaired thoracotomy incision.

pediatricimaging.org • CC-by-nc-sa 4.0

Traumatic

lung hernia: multidetector CT findings and relevance. Additionally, a ventral portion of the left inferior pulmonary lobe was seen herniated (arrowhead) through the 8th intercostal space. Note extrathoracic emphysema (+); nondependent pneumothorax (*).

www.eurorad.org • CC by-nc-sa-4.0

Lung hernia

• Intercostal lung herniation - Ganzer Fall bei Radiopaedia

Nicoletti D, Intercostal lung herniation. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-32352 • CC by-nc-sa 3.0 (modified)

Lung hernia

• Intercostal lung hernia - Ganzer Fall bei Radiopaedia

Cuete D, Intercostal lung hernia. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-22552 • CC by-nc-sa 3.0 (modified)

Lung hernia

• Intercostal lung hernia - Ganzer Fall bei Radiopaedia

Gerstenmaier J, Intercostal lung hernia. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-24935 • CC by-nc-sa 3.0 (modified)

Lung hernia

• Intercostal lung herniation - Ganzer Fall bei Radiopaedia

Wheeler M, Intercostal lung herniation. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-40441 • CC by-nc-sa 3.0 (modified)

Lung hernia

• Acquired intercostal lung hernia complicated by pneumonia - Ganzer Fall bei Radiopaedia

Igler C, Acquired intercostal lung hernia complicated by pneumonia. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-48830 • CC by-nc-sa 3.0 (modified)

Lung hernia

• Intercostal lung hernia - Ganzer Fall bei Radiopaedia

Ranschaert E, Intercostal lung hernia. Case study, Radiopaedia.org (Accessed on 01 Jan 2023) https://doi.org/10.53347/rID-10932 • CC by-nc-sa 3.0 (modified)

Toddler with

progressive respiratory distress and no history of foreign body ingestion. CXR AP and lateral show overinflation of the right upper lobe that is herniating across the midline.

pediatricimaging.org • CC-by-nc-sa 4.0

Lung

herniation post-removal of thoracostomy tube. a A soft reducible mass, prominent on coughing, valselva noted at the site of previous intercostals drainage with overlying sutures. b Chest radiograph (A-P) view showing the presence of a tongue of herniated lung tissue at the right base overlying the herniated tissue. c CT chest showing the cicatricial collapse of the right lung, tractional bronchiectatic changes in the left lung with cavities in bilateral lungs, and presence of aspergilloma in the left apical region with features of pulmonary arterial hypertension. Pleural dehiscence with lung herniation is seen in the right lung

ejb.springeropen.com • CC-by-4.0

Radiopaedia • CC-by-nc-sa 3.0 • de

Intercostal lung hernias are defined as a protrusion of the lung beyond the confines of the thoracic cage. They are uncommon, mostly seen post trauma or thoracotomies.

Clinical presentation

Hernias which are symptomatic may cause dyspnea, chest wall pain or a visible or palpable chest bulge (most common in intercostal lung hernias). They may also be asymptomatic.

Pathology

Lung hernias are classified by their anatomic locations and the mechanism by which they arise (congenital or acquired).

Etiology

They can be either congenital or acquired in origin (classified by Morel-Lavallée in 1847):

congenital
acquired (most common)
- pathological
- inflammatory
- traumatic
- iatrogenic, e.g. post-thoracotomy incision

Location

cervical: ~35%
- protrusion of the lung through the anterior region of the thoracic inlet where there is a space between the scalenus anterior and sternocleidomastoid muscles
- mostly seen in elderly patients with emphysematous lungs with weak cervical fascia
intercostal: ~70% (range 60-83%)
- result of the weakening of the thoracic wall or abnormally elevated intrathoracic pressure (e.g. weightlifters, wind instrument players)
- in post-traumatic cases, the lung herniation may occur immediately after the impact or years later
diaphragmatic: extremely rare

Treatment and prognosis

Asymptomatic lung hernias may be managed by close observation. In symptomatic cases, immediate reduction and closure of the defect are indicated to prevent incarceration and strangulation .

Although lung hernias are rare and usually benign in nature, it is important for physicians to be aware that these entities do exist so that they are not alarmed when they are encountered. Knowledge of the benign nature of lung hernias will prevent the use of unnecessary invasive procedures and surgery.