Imaging: Fellow Case Report Poster - Imaging |

Spontaneous Lung Hernia After Cough FREE TO VIEW

Apurwa Karki, MD; mohammed babury, MD; Viral Patel, MD; Janaya Raynor, MD
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Jamaica Hospital Medical Center, Jamaica, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):648A. doi:10.1016/j.chest.2016.08.742
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SESSION TITLE: Fellow Case Report Poster - Imaging

SESSION TYPE: Affiliate Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Spontaneous lung hernia is a rare presentation, usually occurring after forceful cough or sneeze. It has been reported in patients with obesity, COPD and chronic steroid use.

CASE PRESENTATION: 57-year-old male with past medical history of hypertension, former smoking, and moderate COPD, was admitted with chief complaint of severe cough for 4 days. His cough was associated with mild shortness of breath, yellowish sputum production and left sided pleuritic chest pain. On presentation, vitals were significant for hypertension (151/91), tachycardia (151), and hypoxia (91%) on room air. Physical exam revealed an obese male in mild distress, prominent wheeze, rales bilaterally, associated with chest wall tenderness on palpation and decreased breath sounds in the left lung base. Initial laboratory findings revealed: leukocytosis (14.4) and mild renal insufficiency (Cr: 1.5). ABG showed hypoxia with respiratory alkalosis. CXR showed hyper-inflated lungs with possible left lower lobe infiltrates. The patient was started on IV steroids, antibiotics, bronchodilators, and pain medication. CT imaging revealed, a lung hernia (4 cm anteroposterior X 2.8 cm craniocaudally X 2 cm protrusion) postero-laterally on the left, between the left eighth and ninth rib. Thoracic surgery was consulted, but decision was made to treat medically. Findings have been the cause of patient’s chest wall pain, but were unlikely related to patient's respiratory symptoms. After close observation, cough subsided and chest wall pain improved with treatment of pneumonia and cough suppressant. The patient was followed as an outpatient at months 1 and 4 post discharge. Symptoms had resolved and CT chest findings were unchanged.

DISCUSSION: Asymptomatic hernias, usually do not need intervention. Indications for surgical intervention should be made in cases where hernia is enlarging in size, respiratory decompensation, and inability to reduce the hernia, pain, or hemoptysis. Small defects should be repaired early, as the risk of incarceration is high. Repairs can be made by reduction of the hernia, resection of the sac, and closure of the defect.

CONCLUSIONS: Spotaneous lung herniation occurs often through the eighth and ninth rib space where muscular support is minimal, usually with chronic cough. Symptomatic patient donot require surgery and patients need close outpatient follow up.

Reference #1: Herniation of the lung: a case report.J Emerg Med. 2014 Jan;46(1):28-30. Choe CH et al.

DISCLOSURE: The following authors have nothing to disclose: Apurwa Karki, mohammed babury, Viral Patel, Janaya Raynor

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