Question:

Which of the following is true regarding intercostal lung herniation
1. May not be obvious on chest x-ray
2. Maneuvers that decrease the intrathoracic pressure can make protrude the lung hernia on plain chest radiograph through a chest wall defect
3. Comparing to chest radiograph thoracic CT doesn`t provide further information regarding lung hernias and is rarely needed
4. Contrast enhanced thoracic CT may demonstrate the herniated lung but will not show the hernia sac
5. Lung ultrasound has no role in lung hernia detection due to the hyperechogenicity of the aerated lung tissue





Answer:

The correct answer for the question "Which of the following is true regarding intercostal lung herniation" is:

1. May not be obvious on chest x-ray



Explanation
a)    Unfortunately, lung herniation is not always visible on chest radiographs. [A plain chest radiograph may be the first approach to the diagnosis of an intercostal lung hernia. Herniation may be missed on routine chest radiography unless is at a true tangent to the X-ray beam]

b)    Increase in intrathoracic pressure such as intense coughing and Valsalva maneuver, can make the herniated lung portion further protrude though the chest wall. [Valsalva maneuver, as previously stated, due to the increase in intrathoracic pressure makes the hernia to further protrude through a chest wall defect as a radiolucent circumscribed area beyond the thoracic wall.]

c)    Thoracic CT may better define the dimensions of the herniated lung portion and also identify the chest wall defect

d)     Chest CT may demonstrate not only the lung hernia itself but also the hernia sac and orifice through the chest wall. [Therefore, chest computed tomography (CT) images may demonstrate the herniated lung, the hernial orifice in the chest wall, the hernial sac, as well as their anatomic relation with the pectoral and intercostal muscles]

e)    Transthoracic ultrasound may be useful, together with chest radiograph, as a first approach in the diagnosis of an intercostal lung herniation. [In cases where a CT scanner is not immediately available transthoracic ultrasound may be also useful, together with chest radiograph, as a first approach in the diagnosis of an intercostal lung herniation. Hence, in such case, the aerated lung tissue of the palpable intercostal lump, due to its high acoustic impedance, must be intensively hyperechoic and may cause shadowing, excluding other chest wall pathologies from the differential diagnosis list like haematomas, lipomas and other soft tissue lesions]



From the manuscript:
Intercostal lung herniation - The role of imaging
Radiology Case. 2014 Apr; 8(4):16-24


This article belongs to the Chest section.




Bookmark and Share

From the manuscript

Intercostal lung herniation - The role of imaging

Free full text article: Intercostal lung herniation - The role of imaging

Abstract
Extrathoracic lung hernias can be congenital or acquired. Acquired hernias may be classified by etiology into traumatic, spontaneous, and pathologic. We present a case of a 40-year-old male with a history of bronchial asthma and a blunt chest trauma who presented complaining of sharp chest pain of acute onset that began after five consecutive days of vigorous coughing. Upon physical examination a well-demarcated deformity overlying the third intercostal space of the left upper anterior hemithorax was revealed. Thoracic CT scan showed that a portion of the anterior bronchopulmonary segment of the left upper lobe had herniated through a chest wall defect. The role of imaging, especially chest computed tomography with multiplanar image reconstructions and maximum (MIP) and minimum intensity projection (MinIP) reformats can clearly confirm the presence of the herniated lung, the hernial sac, the hernial orifice in the chest wall, and exclude possible complications such as lung tissue strangulation.






References



1. Donato AT, Hipona FA, Navani S. Spontaneous lung hernia. Chest 1973 Aug; 64(2):254-6
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


2. Francois B, Desachy A, Cornu E, Ostyn E, Niquet L, Vignon P. Traumatic pulmonary hernia: surgical versus conservative management. J Trauma 1998; 44: 217-9
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


3. Morel-Lavallée. Hernies du poumon. Bull Soc Chir Paris 1845-1847;1:75-195.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


4. Hiscoe DB, Digman GJ. Types and incidence of lung hernias. J Thorac Cardiovasc Surg 1955;30:335-42
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


5. Moncada R, Vade A, Gimenez C, Rosado W, Demos TC, Turbin R, Venta L. Congenital and acquired lung hernias. J Thorac Imag 1996;11:75-82
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


6. Glenn C, Bonekat W, Cua A, Chapman D, McFall R. Lung hernia. Am J Emerg Med 1997;15:260-2
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


7. Brock MV, Heitmiller RF. Spontaneous anterior lung hernias. J Thorac Cardiovasc Surg 2000;119(5):1046-7
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


8. Salizberg M. : Pulmonary disorders in Disorders of respiratory tract in children. Edited by Edwin L Kendig Jt., W.B
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


9. Temes RT, Talbot WA, Green DP, Wernly JA. Herniation of the lung after video-assisted thoracic surgery. Ann Thorac Surg 2001;72:606-7
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


10. Athanassiadi K, Bagaev K, Simon A, Haverich A. Lung herniation: a rare complication in minimally invasive cardiothoracic surgery. Eur J Cardiothorac Surg 2008 May;33(5):774-6
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


11. Forty J, Wells FC. Traumatic intercostal pulmonary hernia. Ann Thorac Surg 1990;49:670-1
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


12. Hauser M, Weder W, Largiadèr F, Glazer GM. Lung herniation through a postthoracoscopy chest wall defect: demonstration with spiral CT. Chest 1997;112:558-60
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


13. Weymann A. Szabo G. Images in clinical medicine Lung herniation after minimally invasive cardiothoracic surgery
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


14. Bhamidipati CM, Iyalla KI, Seymour KA, Lutz CJ. Lung hernia following robotic-assisted mitral valve repair. J Card Surg 2012 Jul;27(4):460-3
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


15. Su F, Zoole JB, Thompson RW, Meyers BF, Kuo E. Lung herniation after supraclavicular thoracic outlet decompression. Ann Thorac Surg 2012 May;93(5):1720-2
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


16. Weissberg D, Refaely Y. Hernia of the lung. Ann Thorac Surg 2002; 74:1963-6
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


17. Tack D, Wattiez A, Schtickzelle JC, Delcour C. Spontaneous lung herniation after a single cough. Eur Radiol 2000;10(3):500-2
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


18. O`Shea M, Cleasby. Lung herniation after cough-induced rupture of intercostal muscle. N Engl J Med 2012 Jan 5;366(1):74
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


19. Sainathan S, Pugalenthi A, Danovich S, Fox S, Andaz S. Image of the month. Intercostal lung hernia Arch Surg
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


20. DiMarco AF, Oca O, JP Renston. Lung Herniation - A Cause of Chronic Chest Pain Following Thoracotomy. Chest 1995; 107:877-79
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


21. Stern EJ, Sun H, Haramati LB. Peripheral bronchopleural fistulas: CT imaging features. AJR Am J Roentgenol 1996 Jul;167(1):117-20
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


22. Connell DA, Potter HG, Sherman MF, Wickiewicz TL. Injuries of the pectoralis major muscle: evaluation with MR imaging. Radiology 1999 Mar;210(3):785-91
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


23. Tateishi U, Gladish GW, Kusumoto M, Hasegawa T, Yokoyama R, Tsuchiya R, Moriyama N. Chest wall tumors: radiologic findings and pathologic correlation: part 1. Benign tumors Radiographics
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


24. Light RW. Pleural diseases. 2nd ed Malvern, Pa: Lea & Febiger, 1990; 1-7.
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


25. Bhalla M, Leitman BS, Forcade C, Stern E, Naidich DP, McCauley DI. Lung hernia: radiographic features. AJR Am J Roentgenol 1990;154:51-3
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


26. Marlow S, Campbell T, Davis A, Patel HR. Emergency ultrasound in the diagnosis of traumatic extrathoracic lung herniation. Am J Emerg Med 2013 Mar;31(3):633.e1-2
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


27. Sonett JR, O`Shea MA, Caushaj PF, Kulkarni MG, Sandstrom SH. Hernia of the lung: case report and literature review. Ir J Med Sci 1994;163(9):410-2
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


28. Clark AJ, Hughes N, Chisti F. Traumatic extrathoracic lung herniation. Br J Radiol 2009 Apr;82(976):e82-4
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


29. Maurer E, Blades B. Hernia of the lung. J Thorac Surg 1946; 15:77-98
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


30. de Wijs MJ, Verhagen AF, Tan EC. [Post-traumatic lung herniation]. Ned Tijdschr Geneeskd 2012;156(39):A4863
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine


31. Bikhchandani J, Balters MW, Sugimoto JT. Conservative management of traumatic lung hernia. Ann Thorac Surg 2012 Mar;93(3):992-4
Get full text
Find similar topics on Read this article on PubMed :: Find similar articles on Google scholarScholar :: Search for similar topics with the Radiology specific search engine Radiology search engine




Search for articles with similar topics:

Keyword search:

1. Intercostal lung hernia

2. computed tomography

3. image reformats


This article belongs to the Chest section.


Search for more in the Internet

Peer-reviewed Radiology Search




Discuss it!

Bookmark and Share




© Journal of Radiology Case Reports - The Interactive Radiology Journal
Affiliated journal of Radiolopolis - The International Radiology Community


The Journal of Radiology Case Reports