Imaging: Student/Resident Case Report Poster - Imaging |

Inverted Intercostal Hernia Mimicking as a Chest Wall Tumor After Bullectomy FREE TO VIEW

Faraz Afridi, MD; Dana Perrone, DO; Hammad Bhatti, MD; Muhammad Zulqarnain, MD
Author and Funding Information

University of Central Florida College of Medicine, Orlando, FL

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

Chest. 2016;150(4_S):665A. doi:10.1016/j.chest.2016.08.759
Text Size: A A A
Published online

SESSION TITLE: Student/Resident Case Report Poster - Imaging

SESSION TYPE: Student/Resident Case Report Poster

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

INTRODUCTION: Inverted intercostal hernia is a rare complication after thoracostomy1,2. We present a case where an inverted intercostal hernia presented as an enlarging chest wall tumor.

CASE PRESENTATION: A 56 year-old African American female presented to our clinic for a follow up. She was diagnosed with bullous lung disease 12 years prior. She had been a life long non-smoker and her alpha-1 antitrypsin level was normal. She underwent right upper lobe bullectomy a year ago and left lower lobe bullectomy 6 months later. A follow up CT chest during her current encounter showed an expanding right posterior chest wall tumor with fat consistency (Fig. 1). A chest PET/CT failed to show any metabolic activity in the mass. We initially considered in obtaining a surgical lung biopsy to rule out liposarcoma; however, we elected to perform a MRI of the chest to better delineate the mass. MRI T1-weighted images showed a herniation of subcutaneous fat between the right posterior sixth and seventh ribs suggesting a small defect in the rib cage (Fig. 2) which was created from a chest tube insertion after the initial bullectomy.

DISCUSSION: Inverted intercostal hernia can rarely manifest as a chest wall tumor after thoracostomy or trauma. We hypothesized that the initial right bullectomy created a significant negative pressure within the pleural cavity. This negative pressure coupled with a weakness created in the chest wall from the chest tube tract, caused a herniation of the subcutaneous fat into the plural cavity. A follow up CT chest 1 year later showed that the herniated mass had significantly reduced in size. This was most likely due to it being pushed out from a re-expanding right lung. Surgery has been undertaken in previously reported cases in the literature for inverted intercostal hernias to explore the chest wall masses1,2. However, in our case we used imaging to determine the nature of the mass.

CONCLUSIONS: Inverted intercostal hernia is a rare entity after thoracostomy, where MRI of the chest can better define the mass and may help prevent surgery.

Reference #1: Iwata T, Yasuoka T, Hanada S, et al. Inverted Intercostal Hernia of Soft Tissue Manifested as Slow-Growing Chest Wall Tumor After Thoracotomy. The Annals of Thoracic Surgery. 2010;90(4):1355-1357.

Reference #2: Torres U, Portela-Oliveira E, del Campo Braojos F, Vargas Cardoso L, Soares Souza A. Inverted Intercostal Hernia of Soft Tissue of the Chest Wall: Multi-Detector Computed Tomography Findings. Archivos de Bronconeumología (English Edition). 2013;49(12):553-554.

DISCLOSURE: The following authors have nothing to disclose: Faraz Afridi, Dana Perrone, Hammad Bhatti, Muhammad Zulqarnain

No Product/Research Disclosure Information




Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543