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Background: Lung herniation has been described in case reports or series. There are scare data in the form of original research studies to systematically evaluate this condition. Objective: Our aim was to evaluate lung hernias with a focus on their natural history. Methods: This is a retrospective study at our institution of patients who were found to have lung herniation on imaging between September 2010 and November 2022. Electronic medical record review was performed to extract clinical information regarding patients. Computed tomographic imaging was used to evaluate hernia size and size progression over time with a median follow-up time of 3.8 years. Results: Thirty-eight patients were eligible for analysis. Majority of patients were overweight or obese (31/38), smokers (31/38), had prior thoracic surgery (30/38), and were asymptomatic (33/38). Twenty of 38 patients had stability in hernia size, 12 of 38 patients had hernia size progression, and 6 of 38 patients showed hernia size regression. Younger age was found to be predictive of hernia size progression with age of 60 years being the cut-off for its prediction. Conclusion: Lung hernias typically either remain stable in size or show size progression. Younger age (60 years cut-off) was found to be predictive of size progression. This is the largest systematic investigation at a medical institution to the best of our knowledge of lung hernias which used computed tomographic imaging to follow up lung hernias. Further information could be given to patients with this condition and to clinicians for potential management guidance. [ABSTRACT FROM AUTHOR]

Thoracic hernias are characterized by the protrusion of the thoracic contents outside their normal anatomical confines. This case involves a left pleural effusion secondary to a spontaneous lung intercostal hernia (SLIH) in a 52-year-old male. Imaging revealed herniated pleural fluid in the intercostal space. Intra-operatively, there was herniation of the lung parenchyma into an intercostal defect. Pleural effusion secondary to a SLIH is an indication for surgical repair.

Lung hernia following minimally invasive cardiac surgery is rare with few reported cases in the literature. Surgical repair is debated, and several methods have been described including a variety of synthetic and biological materials. We report a case of a 36-year-old woman who developed lung hernia and a strong retraction of the pectoralis major muscle after minithoracotomy that was performed for mitral valve surgery. The herniated lung was reduced and the chest wall defect was repaired with a non-cross linked acellular dermal matrix (ADM) anchored to the thoracic wall. At a 6-year follow-up, she was asymptomatic and without recurrence of the hernia. Our experience suggests that ADMs are a safe and reliable surgical technique for lung hernia repair due to their biological and mechanical properties, even in those secondary hernias to minithoracotomy where a complete muscle coverage of the matrix could not be provided.

Caverno-chest wall sinus without pleural spillage, a subentity of lung hernia, is a rare presentation of pulmonary tuberculosis resulting from spontaneous communication of the lung parenchymal cavity with the extraparenchymal compartment. This presentation in a completely healthy, young, asymptomatic individual for the first time is unusual. This rare presentation of tuberculosis is being highlighted in this case report.

We present the case of a comorbid patient with Chronic Obstructive Pulmonary disease who developed a pulmonary herniation secondary to a coughing episode. He complained of severe and invalidating somatic pain in the herniation area, pain score was 4 out of 10 in the Verbal Numeric Scale (VNS) at rest, that worsened with cough to 9 out of 10. Buprenorphine and acetaminophen were initiated with only slight improvement in pain. Surgical reparation was discarded. An erector spinae plane nerve block (ESP block) was performed with improvement in the VNS to 0 out of 10 at rest and 6 out of 10 with cough. After the procedure, the patient only needed acetaminophen as analgesic for pain relief, and the improvement was maintained in time. The ESP block was described in 2016, and since then there has been growing evidence of its safety and efficacy in post-operative analgesia for breast, thoracic and abdominal surgery. The main ESP block benefits compared to similar blocks are the relative less incidence of pneumothorax, less systemic absorption of local anaesthetics and the simplicity of its performance. Although there is less evidence in chronic pain, it has been described in the treatment of post thoracotomy chronic pain with good results. This case is described because of the great clinical improvement in an uncommon and very symptomatic disease. [ABSTRACT FROM AUTHOR]

Abstract Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. Multiple imaging modalities are available to evaluate thoracic hernias. Radiographs usually offer the first clue to the diagnosis. Upper gastrointestinal radiography can identify bowel herniation and associated complications. CT and occasionally MR can be useful for further evaluation of these abnormalities, accurately identifying the type of hernia, its contents, associated complications, and provide a roadmap for surgical planning. In this article, we review the different types of thoracic hernias and the role of imaging in the evaluation of these hernias. Teaching Points • Protrusion of lung contents beyond the anatomic confines of the thorax constitutes a hernia. • Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. • Multiple imaging modalities are available to evaluate thoracic hernias. • CT is the imaging modality of choice for identifying thoracic hernias and their complications. • Imaging can provide a roadmap for surgical planning.

Thoracic hernias are characterized by the protrusion of the thoracic contents outside their normal anatomical confines. This case involves a left pleural effusion secondary to a spontaneous lung intercostal hernia (SLIH) in a 52-year-old male. Imaging revealed herniated pleural fluid in the intercostal space. Intra-operatively, there was herniation of the lung parenchyma into an intercostal defect. Pleural effusion secondary to a SLIH is an indication for surgical repair. [ABSTRACT FROM AUTHOR]

Abstract: Thoracic hernias are characterised by either protrusion of the thoracic contents outside their normal anatomical confines or extension of the abdominal contents within the thorax. Thoracic hernias can be either congenital or acquired in aetiology. They can occur at the level of the thoracic inlet, chest wall or diaphragm. Thoracic hernias can be symptomatic or fortuitously discovered on imaging obtained for other indications. Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis. Multiple imaging modalities are available to evaluate thoracic hernias. Radiographs usually offer the first clue to the diagnosis. Upper gastrointestinal radiography can identify bowel herniation and associated complications. CT and occasionally MR can be useful for further evaluation of these abnormalities, accurately identifying the type of hernia, its contents, associated complications, and provide a roadmap for surgical planning. In this article, we review the different types of thoracic hernias and the role of imaging in the evaluation of these hernias.Teaching Points: • Protrusion of lung contents beyond the anatomic confines of the thorax constitutes a hernia.• Complications of thoracic hernias include incarceration, trauma and strangulation with necrosis.• Multiple imaging modalities are available to evaluate thoracic hernias.• CT is the imaging modality of choice for identifying thoracic hernias and their complications.• Imaging can provide a roadmap for surgical planning. [ABSTRACT FROM AUTHOR]

Background Intercostal lung herniation (ILH) is an exceptionally rare condition in pediatric patients, characterized by disruption of fascial planes and intercostal musculature allowing for protrusion of a portion of the lung parenchyma into this space. In most cases it is a consequence of blunt chest trauma. Due to the rarity of the condition, diagnostic and management approaches are based on the experience in adults, where CT is the most often used diagnostic tool, and surgery is the primary management approach. Recent published experience in adult and pediatric patients supports the use of less invasive imaging and management strategies, particularly in otherwise asymptomatic patients, giving us the opportunity to reconsider our clinical approaches in the diagnosis and management of these patients. Methods We present a recent case of posttraumatic ILH. In addition, we conducted a systematic review of the literature. A search of the PubMed, Embase, Ovid, Scopus and Cochrane databases was conducted using a combination of the following search terms: intercostal lung hernia in children, lung herniation in children, traumatic intercostal lung hernia in children. Two authors independently extracted data, reviewed the abstracts, and assessed them for inclusion in the review. Results All reported cases were single case reports, with total of 16 including our patient. All ILH were unilateral. The most common etiology was bicycle handle bar injury 10 (63%). Herniation was found on the anterior chest wall in 13 (81%) patients, and in 3 (19%) was on the anterolateral chest wall. To confirm the diagnosis chest x-ray was used in 14 (88%) patients, CT chest in 7 (44)%, fluoroscopy in 1 (6%), chest ultrasound in 3 (19%), and in 1 patient there was no imaging documented. Management was surgical in 10 patients (63%) including thoracotomy with primary closure in 8 patients and thoracoscopic repair in 2 patients. Six patients (37%) had nonsurgical management by chest strapping, with complete resolution of herniation within 2–6 weeks. There was no reported complications or recurrence following either type of management. Conclusions Postraumatic intercostal lung herniation in children is a rare condition. Including our case reported here, there are only 16 reported cases. In children ILH is mostly seen after blunt chest trauma caused by bicycle handle bar injury. Given the rarity of the condition, the pediatric literature on this subject is scarce, with no published guidelines or evidence based recommendations for imaging and management approaches (surgical vs. nonsurgical). Although rare, the pediatric surgeon should be familiar with this condition in order to avoid potentially harmful, invasive or unnecessary diagnostic and therapeutic approaches that are extrapolated from experience in adult patients. Noninvasive imaging modalities including chest radiographs and ultrasound, and nonsurgical management of posttraumatic intercostal lung herniation should be considered as an initial treatment option in the management of asymptomatic patients. [ABSTRACT FROM AUTHOR]

Intercostal lung hernia is defined as a protrusion of the lung tissue through a chest wall defect. It is an uncommon condition after a lobectomy, and most cases are asymptomatic. We herein report a case of intercostal lung hernia after a thoracoscopic right upper lobectomy in a patient whose chief complaint was hemosputum. Elevated intrathoracic pressure is a major risk factor for intercostal lung hernia. In this patient, obesity and bronchial asthma were considered the causes of this disease. Three reports on intercostal lung hernia after thoracoscopic lobectomy were previously published. In three of the four lung hernia cases (including our own), right upper lobectomy had been performed, and the middle lobe was herniated. We consider right upper lobectomy to be an anatomical risk factor. [ABSTRACT FROM AUTHOR]

Introduction: In this paper we present a new method of pulmonary hernia surgical treatment. Pulmonary hernia is a rare pathology. The first description of pulmonary hernia was made by Roland in 1499. The world literature describes only a little more than 300 cases of pulmonary hernia. Pulmonary hernia is defined as the projection of the lung tissue covered by the parietal pleura beyond the normal boundaries of the pleural cavity, through the pathological holes in the chest wall. During our work as thoracic surgeons, we have used different ways of thoracic chest wall reconstructive operations and anastomoses of the broken ribs. Aim of the study: To search for optimal methods of pulmonary hernia surgery and to evaluate a new technique of pulmonary hernia surgical repair using intramedullary titanium implants. Material and methods: In 2013 in our clinic, we diagnosed and cured two patients with idiopathic pulmonary hernia. We performed a reconstructive operation of the chest wall with anastomosis of the broken ribs using titanium intramedullary stabilization implants - splints. Results: To date, the annual observation has revealed no recurrence of pulmonary hernia or postoperative complications. At present, the patients demonstrate full life activity. Conclusions: So far, in the world literature, we have not encountered any information about using such methods to repair pulmonary hernia. We regard our method as safe, easy to use and giving good therapeutic results. [ABSTRACT FROM AUTHOR]

Lung herniation is a relatively rare clinical entity that is most commonly either congenital or acquired traumatically. We describe a case of spontaneous lung herniation secondary to acute cough in an obese male smoker complicated by contralateral acute lung injury and systemic inflammatory response syndrome (SIRS). Mechanisms of lung herniation, classification, diagnosis, and management will be discussed. [ABSTRACT FROM AUTHOR]

Introduction The Organ Injury Scale for chest wall trauma, last updated in 1992, governs the diagnosis and management of nearly half of all trauma patients. When this scale is used in association with the abbreviated injury score (AIS) and the trauma injury severity score (TRISS), overall survival following trauma can be estimated. There is presently no standardized scoring system for blunt chest wall trauma in the setting of lung herniation. Methods A systematic review of the literature on blunt chest wall trauma was completed and all reports of lung hernias since 1500 compiled. Four hundred cases of blunt trauma to the chest leading to lung herniation were identified and used to develop a classification scheme for extrathoracic lung herniation, adapt the organ injury scale for chest wall trauma to include extrathoracic lung hernias, and elucidate a treatment algorithm based on the type of lung hernia. Results Lung hernias can be divided into anterior and posterior; anterior hernias can be further divided into intercostal and parasternal. Intercostal hernias should be managed acutely by way of anterior chest wall exposure and potential thoracotomy due to the significantly higher risk of incarceration and/or strangulation. Discussion Anterior lung hernias should be grade III (AIS 3), parasternal lung hernias as grade IV (AIS 4), posterior lung hernias or the presence of any incarcerated lung as grade V (AIS 4), and strangulated lung hernias as grade VI (AIS 5). Incarcerated or strangulated lung has a high reported morbidity and mortality. [ABSTRACT FROM AUTHOR]

The article presents a study which evaluates the perfusion of lung tissue on human fetuses who have congenital diaphragmatic hernia (CDH) and its relationship with pulsed Doppler and the lung area to head circumference ratio (LHR). The study compares fetuses that were identified with isolated left CDH and fetuses group without CDH and uses fractional moving blood volume (FMBV) to measure the lung tissue perfusion. Results show the decrease in the lung tissue perfusion of the fetuses with CDH.

Abstract: We present herein a rare case of diaphragmatic rupture due to violent coughing during tracheostomy. A 73-year-old man was admitted with cough, hoarseness and dysphagia caused by a huge laryngeal cancer obstructing the airways. Immediate emergency tracheostomy was performed, during which he experienced violent paroxysmal coughing, and he began to complain of right upper abdominal discomfort after tracheostomy. Chest radiography and computed tomography 4 days later showed right diaphragmatic rupture, through which small bowel loops had herniated into the right hemithorax. Diaphragmatic rupture with a 20-cm long fresh oblique tear was repaired through subsequent surgical treatment. Violent paroxysmal coughing during tracheostomy was considered likely to have caused this rare complication. [Copyright &y& Elsevier]

Lung herniation (LH) is a rare clinical entity involving the protrusion of lung outside the thoracic cage. It has a variety of etiologies and clinical presentations, making diagnosis difficult. We present a case of a 20-year-old male who reported pleuritic pain after falling from a skateboard. Evaluation through computed tomography (CT) scanning of the chest revealed an anterior lung hernia associated with rib fractures. This case emphasizes the need for clinicians to include lung herniation in the differential diagnosis of patients with trauma and inexplicable or persistent pulmonary issues. [ABSTRACT FROM AUTHOR]

Pulmonary hernia extending into the chest wall is a rarely seen disease, occurring mostly after trauma associated with the fracture of ribs. It can present immediately after the injury or even years later. Symptoms are usually minimal and infrequent. Patient can present to us with a soft reducible bulge on the chest, moving and altering with respiration, coughing and straining, pain dyspnea, and chest infections. The diagnosis is made clinically and radiographically. Conservative management for smaller hernias with no symptoms and surgical interventions for larger, symptomatic hernias posing threats of strangulation or incarceration is indicated. We report a case of a 40-year-old male who had suffered a blunt chest trauma and later presented to us with an acquired traumatic thoracic lung hernia. [ABSTRACT FROM AUTHOR]

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: BackgroundLung hernia is uncommon and methods of management vary. During the past 17 years, we have seen 8 patients with this condition.: MethodsBetween 1984 and 2000, 8 patients with lung hernias were seen on our service. Three hernias were caused by a thoracic operation, one was due to chronic cough, and in four, the hernia was congenital, with delayed presentation.: ResultsThree patients had minimal symptoms and were not operated on. Closure of chest wall in the other patients was accomplished by suture approximation of ribs in 4 patients and by polypropylene mesh in 1 patient. There were no recurrences, and these patients remain asymptomatic.: ConclusionsIntercostal hernias are usually symptomatic and should be treated by operative closure. In supraclavicular hernias, the symptoms are usually minimal and complications are unlikely. These hernias can be left untreated, but the patients should be followed. [Copyright &y& Elsevier]

Introduction. The persistent morbidity and mortality of congenital diaphragmatic hernia are largely due to associated pulmonary hypoplasia. We have shown previously that three antioxidants (vitamin C, glutathione, and vitamin E) could accelerate the growth of fetal hypoplastic lungs grown in culture. We hypothesize that this occurs via a reductant mechanism.Methods. Timed-pregnant rats were gavage-fed nitrofen (100 mg) on day 9.5 of gestation (term = day 22). Fetal lungs were harvested on day 13.5 and placed in organ culture containing serum-free BGJb medium with antibiotics. After randomization, the lung organ cultures were divided into a control group (n = 31) and an experimental group that received the antioxidant N-acetylcysteine (NAC, 100 μM, n = 31). The fetal lung organ cultures were grown for 4 days at 37°C with 5% CO2. Computer-assisted digital tracings of the airways were performed daily on live, unstained specimens, and lung bud count, perimeter, and area were measured. After 4 days, lungs were pooled, homogenized, and assayed for reduced and oxidized glutathione, normalized to protein, as an estimate of the tissue redox potential. Data were expressed as means ± SEM, and statistical comparisons were performed using Student''s unpaired t test, with P < 0.05 considered significant.Results. Area, perimeter, lung bud count, and complexity (as measured by the perimeter/square root of area) were all significantly increased with NAC treatment from day 2 onward. Reduced glutathione levels were significantly increased following NAC administration (67.1 ± 5.8 versus 37.5 ± 4.2 μmol/mg, P = 0.0004). The ratio of reduced to oxidized glutathione was 2.23.Conclusions. N-Acetylcysteine stimulates nitrofen-induced hypoplastic fetal lung growth in organ culture and increases the ratio of reduced to oxidized glutathione. These data support the concept that oxidation–reduction (redox) may be an important control mechanism for fetal lung growth. [Copyright &y& Elsevier]

Background: Intrinsic positive end expiratory pressure (PEEPi) constitutes an inspiratory threshold load on the respiratory muscles, increasing work of breathing. The role of continuous positive airway pressure (CPAP) in alleviating PEEPi in patients with severe stable chronic obstructive pulmonary disease is uncertain. This study examined the effect of CPAP on the inspiratory threshold load, muscle effort, and lung volume in this patient group.Methods: Nine patients were studied at baseline and with CPAP increasing in increments of 1 cm H(2)O to a maximum of 10 cm H(2)O. Breathing pattern and minute ventilation (I), dynamic PEEPi, expiratory muscle activity, diaphragmatic (PTPdi/min) and oesophageal (PTPoes/min) pressure-time product per minute, integrated diaphragmatic (EMGdi) and intercostal EMG (EMGic) and end expiratory lung volume (EELV) were measured.Results: Expiratory muscle activity was present at baseline in one subject. In the remaining eight, PEEPi was reduced from a mean (SE) of 2.9 (0.6) cm H(2)O to 0.9 (0.1) cm H(2)O (p<0.05). In two subjects expiratory muscle activity contributed to PEEPi at higher pressures. There were no changes in respiratory pattern but I increased from 9.2 (0.6) l/min to 10.7 (1.1) l/min (p<0.05). EMGdi remained stable while EMGic increased significantly. PTPoes/min decreased, although this did not reach statistical significance. PTPdi/min decreased significantly from 242.1 (32.1) cm H(2)O.s/min to 112.9 (21.7) cm H(2)O.s/min). EELV increased by 1.1 (0.3) l (p<0.01).Conclusion: High levels of CPAP reduce PEEPi and indices of muscle effort in patients with severe stable COPD, but only at the expense of substantial increases in lung volume. [ABSTRACT FROM AUTHOR]

Lung herniation, where the lung and its visceral and parietal components protrude outwards from a defect in the chest wall, is not common. It is most commonly secondary to blunt or penetrating trauma. The diagnosis is difficult, as the presentation differs according to aetiology. Ultrasound or CT scanning help in diagnosis and treatment planning. We present a 70-year-old female patient with lung herniation following a cow's kick on the thorax.

The article presents a case study of a 15-year-old female Lhasa Apso dog that was presented with a history of chronic bronchitis and concurrent left-sided heart problem. Topics discussed include diagnosis of cranial lung herniation and left-sided heart disease, development of a slight increase in liver enzyme activities confirmed by blood biochemical tests, and radiographic examinations revealed cardiorespiratory abnormalities.

Abstract: Background: Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia. Objectives: To discuss the presentation of a patient found to have a spontaneous lung and bowel herniation, and to review the literature regarding these entities. Case Report: A 61-year old gentleman with a history of chronic obstructive pulmonary disease and previous long-standing smoking history presented with complaints of right-sided chest pain and cough. He was found to have a spontaneous right lateral lung herniation. This was managed expectantly, but the patient subsequently developed spontaneous right-sided diaphragmatic rupture and herniation of bowel contents through the chest wall. Conclusion: To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma. [Copyright &y& Elsevier]