New left sided chest wall lump. The lump is more noticeable after a bout of coughing and the patient is able to partially push the lump back into his chest wall. He has a history of COPD and is on long term glucocorticoid therapy. There is no history of trauma.
CT image shows an intercostal lung herniation seen in the left side within the intercostal margin.
Despite there being no evidence of trauma, this patient has suffered multiple rib fractures secondary to chronic cough and long term steroid use. This has then resulted in an acute intercostal lung herniation through the chest wall deformity and intercostal muscle weakness. Although the patient was aware of the hernia he was otherwise asymptomatic and happy to be managed conservatively.