Edit concept Question Editor Create issue ticket

Lung Hernia

Hernias Lung

A lung hernia, defined as the protrusion of the tissue of the lung through a defect in the thoracic wall, is a rare clinical entity that may develop after sudden increases in intrathoracic pressure, together with predisposing conditions that disrupt the normal anatomical structure of the chest wall. Congenital abnormalities, infections, tumors, surgical procedures, and trauma are some of the most common causes. Imaging studies are needed to confirm the diagnosis.


Presentation

Protrusion of the lung parenchyma through a tear in the chest wall is termed lung herniation, or a lung hernia, which is not commonly seen in clinical practice [1] [2]. It is established that extreme and sudden increases in the intrathoracic pressure on one hand (eg. sneezing, heavy weight-lifting, long-term steroid use in chronic obstructive pulmonary disease, or playing a musical instrument), and a pre-existing weakness of the chest wall on the other, must be present in order for a lung hernia to develop [1] [2] [3] [4] [5]. The broad classification of lung hernias is based on two features: the anatomical location (as protrusion through the diaphragm- diaphragmatic, the intercostal spaces- thoracic, and the cervical portion of the chest wall may be seen) and the etiology, further divided into spontaneous and secondary to congenital defects and acquired causes (trauma, infections, tumors, etc.) [2]. The term "pathological hernia" is used to describe lung herniation induced by conditions such as tuberculosis, focal bacterial infections (empyema or osteomyelitis), and malignant diseases [1]. About half of all lung hernias, however, appear after trauma to the chest [5]. Patients may be asymptomatic (typical for uncomplicated spontaneous hernias), but a subcutaneous mass that is soft and tender on palpation and often enlarges after a Valsalva maneuver is the typical clinical presentation [1] [6]. Chest pain and recurrent infections are common symptoms as well [7].

Asymptomatic
  • In asymptomatic individuals, lung hernia is incidentally detected in a chest X-ray taken for another reason. On physical examination, a prominence or mass is seen during Valsalva maneuver.[en.wikipedia.org]
  • Patients may be asymptomatic (typical for uncomplicated spontaneous hernias), but a subcutaneous mass that is soft and tender on palpation and often enlarges after a Valsalva maneuver is the typical clinical presentation.[symptoma.com]
  • Some hernias are asymptomatic and no treatment is necessary.[ncbi.nlm.nih.gov]
  • They may also be asymptomatic. Lung hernias are classified by their anatomic locations and the mechanism by which they arise (congenital or acquired).[radiopaedia.org]
  • Lung herniation post CPR has been very rarely described earlier, and a study conducted by Krischer et al. of 705 post-CPR autopsies did not report even a single case of lung herniation. [2] Most patients with lung herniation remain asymptomatic and a[jpgmonline.com]
Lymphadenopathy
  • Examination of his chest at rest was normal, without any cervical lymphadenopathy or signs of superior vena cava obstruction ( figure 1A ). Examination while coughing revealed a visible swelling on the right side of the neck ( figure 1B ).[thorax.bmj.com]
  • There was no significant lymphadenopathy. Chest examination revealed an ill-defined, smooth, nontender, soft, fluctuant swelling of 4 4 cm size located close to the sternum overlying the right second and third intercostal spaces.[lungindia.com]
  • No cervical lymphadenopathy was detected. Examination while coughing revealed a visible swelling on the right side of the neck. Chest radiograph was normal.[latunisiemedicale.com]
Pallor
  • In the night following admission the patient had acute cardiovascular decompensation with worsening dyspnea, pallor and hypotension.[ncbi.nlm.nih.gov]
  • In the night following admission the patient had an acute cardiovascular decompensation with worsening dyspnea, pallor and hypotension.[thieme-connect.com]
Agent Orange
  • Past Medical History He had hypertension, hypothyroidism, gout, an umbilical hernia, hyperlipidemia, diverticulosis, and a peripheral neuropathy due to Agent Orange exposure.[swjpcc.com]
Hunting
  • Wiens S, Hunt I, Mahood J, Valji A, Stewart K, et al. (2009) Novel fixation technique for the surgical repair of lung hernias.Ann ThoracSurg 88: 1034-1035.[omicsonline.org]
Sputum
  • Moreover, when the patient is unable to expectorate sputum sufficiently due to postoperative pain, adequate analgesia may be necessary to prevent lung atelectasis.[surgicalcasereports.springeropen.com]
  • Three sputum smears were negative for acid fast bacilli. Chest roentgenogram revealed an ill-defined homogenous opacity in the right paracardiac region.[lungindia.com]
Chest Wall Pain
  • 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.[radiopaedia.org]
Stridor
  • Results: A previously healthy 9 month-old girl was evaluated with a several week history of progressive stridor and dysphagia. The stridor was more pronounced with crying and especially noted with crawling.[csurgeries.com]
Productive Cough
Abdominal Bruising
  • He was unable to take in a deep breath or lie flat and developed an abdominal bruise shortly after the tearing pain. He denied fever, dizziness or change in his baseline clear phlegm.[swjpcc.com]
Long Leg
  • The patient was discharged after application of a long leg cast. The patient presented to our ER three days later complaining of hemoptysis, dyspnea, chest pain, and swelling of the left chest.[jtd.amegroups.com]
Musculoskeletal Pain
  • He was treated with analgesics for musculoskeletal pain and then he was treated with antiplatelet for suspected angina.[omicsonline.org]

Workup

Lung hernias are frequently diagnosed months or even years after the initial pathological event due to the asymptomatic course until the repetitive sudden rise in intrathoracic pressure causes a more pronounced clinical presentation [4] [6]. The workup should start with a detailed patient history that will evaluate recent trauma, surgical procedures such as thoracotomy, or preexisting strenuous activities that may have led to the appearance of symptoms. A thorough physical examination must be performed soon after, and a careful inspection and palpation of the chest can often be sufficient to detect a visible defect and the protrusion of lung tissue as a soft and tender mass. To confirm the diagnosis, however, imaging studies are the cornerstone. Plain radiography is a useful first-line method that can show protrusion of the lungs beyond the rib cage and a wider intercostal space [1]. Anteriorly, the space between the eighth and ninth rib is considered to be a common place for lung hernias to occur (due to the absence of intercostal muscles), while the area from the vertebrae to the costal angle is observed as a vulnerable site posteriorly [1]. Ultrasonography is also regarded as a good method by some authors [4], but computed tomography (CT) is widely recognized as the gold standard for evaluation of lung hernias [7]. The exact location, the severity of protrusion, as well as the assessment of adjacent soft tissues, is performed in a superior manner by CT compared to X-rays and ultrasonography [1] [2] [4] [5].

Right Pleural Effusion
Normal Chest X-Ray
  • Hemogram was normal. Chest X-ray postero-anterior view showed haziness over left lower zone ( Figure 1 ).[omicsonline.org]
Pleural Adhesions
  • Therefore, we used a dual-layered material to provide strength to the repair, and to prevent pleural adhesion. Conclusions In this case, the patient presented after a traumatic injury, complaining of pain and hemoptysis.[jtd.amegroups.com]

Treatment

  • Treatment consisted of excision of the sac and repair. Demonstration of the defect roentgenographically and on physical examination is diagnostic. The defect can regress spontaneously; surgery is frequently curative, although techniques vary.[ncbi.nlm.nih.gov]
  • Some hernias are asymptomatic and no treatment is necessary.[ncbi.nlm.nih.gov]
  • Learn more about Cancer treatment at UPMC Pinnacle. Hiatal Hernia Hiatal hernia surgery can be performed as a laparoscopic, or "minimally invasive," procedure.[pinnaclehealth.org]
  • Lung hernia is an extremely rare condition and the treatments vary. We report a case of cervical lung hernia without any trauma. The patient underwent video-assisted repair with a satisfactory result.[ncbi.nlm.nih.gov]
  • The surgical principles for the treatment of flail chest have yet to be fully established. Furthermore, the relationship between flail chest and lung hernias is unclear.[ncbi.nlm.nih.gov]

Prognosis

  • […] 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[radiopaedia.org]
  • If the LHR is 1 or less, the prognosis is poor. The prognosis is poorer still if the liver is in the thorax. Such patients may be candidates for prenatal intervention.[perinatology.com]
  • In rare cases with the worst prognosis, intervention before birth to include single port endoscopic fetal tracheal occlusion to allow accelerated lung growth will be offered.[med.brown.edu]
  • Epidemiology and Prognosis of Congenital Diaphragmatic Hernia: A Population-Based Cohort Study in Utah. Birth Defects Res. 2017 Sep 19. [Medline]. Clark RH, Hardin WD Jr, Hirschl RB, et al.[emedicine.medscape.com]
  • The fetal sonographic examination was not suggestive of a poor prognosis (lung to thorax transverse area ratio, 0.17; observed/expected lung area to head circumference ratio, 51%).[jsum.or.jp]

Etiology

  • The broad classification of lung hernias is based on two features: the anatomical location (as protrusion through the diaphragm- diaphragmatic, the intercostal spaces- thoracic, and the cervical portion of the chest wall may be seen) and the etiology,[symptoma.com]
  • Etiology They can be either congenital or acquired in origin (classified by Morel-Lavallee in 1847): congenital acquired (most common) pathological inflammatory traumatic iatrogenic, e.g. post-thoracotomy incision 3 Location cervical: 35% protrusion of[radiopaedia.org]
  • Pulmonary hernias are classified according to their etiology (Fig. 1), of which the majority(except in children) are secondary to open or closed thoracic traumatisms.[epos.myesr.org]
  • Related article at Pubmed, Scholar Google Keywords Lung hernia; Trauma; Hernia/surgery; Lung diseases/ etiology Introduction Herniation of lung is seen uncommon clinically.[omicsonline.org]
  • This case illustrates the need to consider unusual etiologies of a common clinical presentation.[swjpcc.com]

Epidemiology

  • Epidemiology and Prognosis of Congenital Diaphragmatic Hernia: A Population-Based Cohort Study in Utah. Birth Defects Res. 2017 Sep 19. [Medline]. Clark RH, Hardin WD Jr, Hirschl RB, et al.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology The pathophysiology of CDH involves pulmonary hypoplasia, pulmonary hypertension, pulmonary immaturity, and potential deficiencies in the surfactant and antioxidant enzyme system.[emedicine.medscape.com]

Prevention

  • Knowledge of the benign nature of lung hernias will prevent the use of unnecessary invasive procedures and surgery.[en.wikipedia.org]
  • The lung hernia was repaired surgically to relieve pain, prevent incarceration, and optimize respiratory function. After a brief period of postoperative ventilation, the patient recovered markedly and has been well since.[ncbi.nlm.nih.gov]
  • The majority of cases reported in the literature have been treated surgically with early thoracotomy to prevent strangulation of pulmonary tissue.[ncbi.nlm.nih.gov]
  • In symptomatic cases, immediate reduction and closure of the defect are indicated to prevent incarceration and strangulation 3 .[radiopaedia.org]
  • […] of a larger defect. 3 4 Tearing of the fascia and spontaneous hernias have been described in players of wind instruments, weightlifters and those with a chronic cough, which may have occurred in our patient. 2 5 The defect is usually large enough to prevent[thorax.bmj.com]

References

Article

  1. Wani AS, Kalamkar P, Alhassan S, Farrell MJ. Spontaneous intercostal lung herniation complicated by rib fractures: a therapeutic dilemma. Oxf Med Case Reports. 2015;2015(12):378-381.
  2. Shankar S, Abbas A. Acute Respiratory Failure Caused by Spontaneous Herniation of the Lung. Ochsner J. 2010;10(4):256-258.
  3. Athanassiadi K, Bagaev E, Simon A, Haverich A. Lung herniation: a rare complication in minimally invasive cardiothoracic surgery. Eur J Cardiothorac Surg. 2008;33(5):774-776.
  4. Detorakis EE, Androulidakis E. Intercostal lung herniation - The role of imaging. J Radiol Case Rep. 2014;8(4):16-24.
  5. Abu Tair A, Kull C, Rosenberg R, Mechera R. Lateral lung hernia following a low-energy trauma without bony injuries: A case report. Int J Surg Case Rep. 2016;24:54-56.
  6. Weissberg D. Lung hernia - a review. Adv Clin Exp Med. 2013;22(5):611-613.
  7. Eisa N, Alraiyes AH, Shaheen K, Alraies MC. Lung hernia. BMJ Case Rep. 2013;2013:bcr2013009391.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 22:30