Intercostal lung herniation

Case contributed by Dr Matthew Wheeler

Presentation

Gentleman in his sixties presents with a 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.

Patient Data

Age: 60s
Gender: Male
X-ray

CXR shows hyperinflation and old healed left sided rib fractures. Air can also be seen lateral to the ribs on the lower left zone.

CT

CT image shows an intercostal lung herniation seen in the left side within the intercostal margin.

Case Discussion

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.

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Case information

rID: 40441
Case created: 21st Oct 2015
Last edited: 22nd Oct 2015
System: Chest
Inclusion in quiz mode: Excluded

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