Intercostal lung hernia

Case contributed by Dr Erik Ranschaert

Presentation:

IC-patient with persisting pain in chest, clinical suspicion of pulmonary embolism.

Chest X-ray

Modality: X-ray

A subtle extrathoracic air collection is seen adjacent to the left lower chest wall 

CT CHEST (SELECTED IMAGES)

Modality: CT

The CT images clearly show an intercostal herniation of lung parenchyma, especially in the lung window settings. Also note the emphysematous changes in both lungs, especially in the apical lobes (in lung window setting).

Case Discussion:

Intercostal lung herniations are usually caused by a combination of increased intrathoracic pressure and a weakened chest wall. 

  • the cause is most frequently post-traumatic or iatrogenic (52%), 
  • COPD with emphysema is less frequently a causative factor (18%). 
  • in 30% of the cases herniations occur spontaneously (during weight lifting, glass blowing or trumpet playing...). 
  • congenital herniations are less frequent

Patients usually present with a local swelling of the chest wall, acute chest pain or a focal painful mass on the chest. 

A possible complication is incarceration or strangulation of pulmonary tissue, causing pain and haemoptysis. Treatment is surgical.

See article: Lung Hernia

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