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Medical Science Monitor Basic Research


A 64-Year-Old Man with Traumatic Right Middle Lobe Lung Herniation Successfully Managed Conservatively

Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Rare disease

Walter J. Morales Borrero, José Madonado Vargas

Puerto Rico Section of Diagnostic Radiology, School of Medicine, University of Puerto Rico (UPR) Medical Sciences Campus, San Juan, Puerto Rico

Am J Case Rep 2021; 22:e931446

DOI: 10.12659/AJCR.931446

Available online: 2021-05-12

Published: 2021-06-19


BACKGROUND: Intercostal lung hernias can be congenital or acquired and involve a protrusion of lung tissue beyond the thoracic cage. Post-traumatic intercostal lung hernias can present with symptoms of pain and dyspnea or can be asymptomatic. This report is of a case of traumatic right middle lobe lung herniation through the intercostal junction of the fourth and fifth ribs in a 64-year-old man that was successfully managed conservatively.
CASE REPORT: This is the case of a 64-year-old man who presented to the Emergency Department reporting intense pain in the right hemithorax and shortness of breath after blunt trauma to the chest following a fall from the second floor of his house. The initial chest X-ray revealed a moderate right pneumothorax. Immediately afterward, a computerized tomography scan of the chest revealed a right middle lobe intercostal lung herniation through a defect in the costochondral junction of the fourth and fifth ribs. Despite the aforementioned imaging findings, the patient did not develop respiratory distress warranting a surgical correction of his intercostal hernia. Therefore, a conservative approach based on close clinical observation and pain management was employed, without further reported complications. Follow-up after 1 year was unremarkable for complications, increased morbidity, or further visits to the hospital.
CONCLUSIONS: This report has presented a rare case of intercostal lung herniation following trauma that was confirmed on imaging. Furthermore, this case has shown that surgical intervention is not required in asymptomatic patients, as this patient was managed conservatively and remained asymptomatic at follow-up.

Keywords: Emergency Medical Services, Lung, Radiography, Thoracic