Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery

Lung hernia, the protrusion of pulmonary tissue outside of the thoracic cage, is a rare radiologic finding. The exact incidence of this condition is not well documented. The etiology is either secondary to underlying congenital conditions which weaken the supporting structures of the thoracic wall o...

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Main Authors: Amanda L. Rugg, BS, Jason J. Lee, MD
Format: Article
Language:English
Published: Elsevier 2022-03-01
Series:Radiology Case Reports
Subjects:
Online Access:http://www.sciencedirect.com/science/article/pii/S1930043321008773
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author Amanda L. Rugg, BS
Jason J. Lee, MD
author_facet Amanda L. Rugg, BS
Jason J. Lee, MD
author_sort Amanda L. Rugg, BS
collection DOAJ
description Lung hernia, the protrusion of pulmonary tissue outside of the thoracic cage, is a rare radiologic finding. The exact incidence of this condition is not well documented. The etiology is either secondary to underlying congenital conditions which weaken the supporting structures of the thoracic wall or more commonly, post-surgical changes. In this report, we describe the case of a 58-year-old male trauma patient who was involved in a motor vehicle collision. Computed tomography of the head, neck, body, and upper extremities was negative for acute injury, but an incidental left-sided herniation of the lingula between the fifth and sixth intercostal spaces was identified. Computed tomography is superior for identifying imaging lung herniations as chest radiographs may not visualize the defect. Upon further investigation, the patient had a remote history of pneumonia complicated by empyema treated by video-assisted thoracoscopic surgery (VATS). This history, coupled with the absence of traumatic injury to the thorax as well as the presence of pulmonary scarring suggests that the lung herniation was likely chronic and secondary to the VATS procedure. The patient was discharged home without surgical intervention. Asymptomatic lung herniations are typically managed conservatively, but patients and physicians should be aware of the risk of lung hernia after VATS as well as associated complications including strangulation or pulmonary infarct.
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spelling doaj.art-a286c2a3bae34ed7bded488096d232d62022-12-21T17:24:30ZengElsevierRadiology Case Reports1930-04332022-03-01173798801Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgeryAmanda L. Rugg, BS0Jason J. Lee, MD1University of Arizona College of Medicine, Department of Medical Imaging, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ 85724, USACorresponding author.; University of Arizona College of Medicine, Department of Medical Imaging, 1501 N. Campbell Ave, P.O. Box 245067, Tucson, AZ 85724, USALung hernia, the protrusion of pulmonary tissue outside of the thoracic cage, is a rare radiologic finding. The exact incidence of this condition is not well documented. The etiology is either secondary to underlying congenital conditions which weaken the supporting structures of the thoracic wall or more commonly, post-surgical changes. In this report, we describe the case of a 58-year-old male trauma patient who was involved in a motor vehicle collision. Computed tomography of the head, neck, body, and upper extremities was negative for acute injury, but an incidental left-sided herniation of the lingula between the fifth and sixth intercostal spaces was identified. Computed tomography is superior for identifying imaging lung herniations as chest radiographs may not visualize the defect. Upon further investigation, the patient had a remote history of pneumonia complicated by empyema treated by video-assisted thoracoscopic surgery (VATS). This history, coupled with the absence of traumatic injury to the thorax as well as the presence of pulmonary scarring suggests that the lung herniation was likely chronic and secondary to the VATS procedure. The patient was discharged home without surgical intervention. Asymptomatic lung herniations are typically managed conservatively, but patients and physicians should be aware of the risk of lung hernia after VATS as well as associated complications including strangulation or pulmonary infarct.http://www.sciencedirect.com/science/article/pii/S1930043321008773Lung herniationVideo-assisted thoracoscopic surgeryLingulaIntercostalTrauma
spellingShingle Amanda L. Rugg, BS
Jason J. Lee, MD
Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
Radiology Case Reports
Lung herniation
Video-assisted thoracoscopic surgery
Lingula
Intercostal
Trauma
title Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
title_full Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
title_fullStr Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
title_full_unstemmed Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
title_short Incidental finding of lung hernia in a patient with a remote history of empyema status post video-assisted thoracoscopic surgery
title_sort incidental finding of lung hernia in a patient with a remote history of empyema status post video assisted thoracoscopic surgery
topic Lung herniation
Video-assisted thoracoscopic surgery
Lingula
Intercostal
Trauma
url http://www.sciencedirect.com/science/article/pii/S1930043321008773
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