Intercostal lung hernia

Case contributed by Dr Erik Ranschaert

Presentation

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

X-ray

Chest X-ray

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

CT

CT Chest (selected images)

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 weightlifting, 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 hemoptysis. Treatment is surgical.

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Case information

rID: 10932
Published: 2nd Oct 2010
Last edited: 13th Aug 2019
System: Chest
Inclusion in quiz mode: Included

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