[Lung hernia provoked by a cough fit]

Surgical Repair of Spontaneous Lung Herniation Induced by Vigorous Coughing: A Case Report and Literature Review

Lung herniation is a rare clinical entity defined by extrathoracic protrusion of the lung or lung tissue due to a weakness in the thoracic wall. We present here a case of a 72-year-old male who presented with a spontaneous lung herniation, which occurred as a result of a ventral luxation of the third rib from the sternocostal joint due to vigorous coughing. The defect was repaired through anterolateral thoracotomy, reposition of the lung and approximating the ribs using heavy sutures. The postoperative course of the patient was uncomplicated. A brief review of the literature is also provided.

Incidental discovery of intercostal pulmonary hernia: A case report

Lung hernias are rare. They are defined by the protrusion of lung parenchyma through a defect in the chest wall. A distinction is classically made between supraclavicular, thoracic or diaphragmatic hernias and congenital or acquired hernias. The latter can be classified by etiology as post-traumatic, postoperative, or pathological but can be spontaneous (even rarer) caused mainly by coughing efforts. The diagnosis is guided by the clinical presentation and confirmed by radiographic analysis, especially CT scan. The management, by conservative or surgical approach, depends on the clinical condition of the patient, the characteristics of the hernia and the existence or not of complications. We report the case of a 58-year-old patient, chronic smoker with no history of trauma, who presented with a chronic cough not improved by symptomatic treatment and in whom the clinical examination was without particularities. Chest CT scan showed discrete pulmonary emphysema with an intercostal pulmonary herniation at the level of the right fifth intercostal space associated with a bony outgrowth at the level of the middle arch of the right fifth rib. The pulmonary protrusion occurred through a parietal defect between the fifth rib and the bony protrusion. The management consisted of conservative treatment of the hernia with close clinical and radiological follow-up and medical treatment of the pulmonary emphysema and chronic cough associated with smoking cessation and hygienic and dietary rules.