Question:

Which of the following answers is false regarding thoracic CT scan in case of lung herniation:
1. Axial, coronal and sagittal reconstruction images may be useful for the assessment, localization and the extent of the herniated lung portion
2. MIP reformats in contrast-enhanced chest CT are useful in order to exclude strangulation lung tissue
3. MIP reformats may help exclude possible bronchi occlusion
4. Intravenous contrast media administration is never needed in case of lung hernia
5. Volume rendered technique 3D images create an overview of the lung hernia as well as of the chest wall defect





Answer:

The correct answers for the question "Which of the following answers is false regarding thoracic CT scan in case of lung herniation:" are:

3. MIP reformats may help exclude possible bronchi occlusion

4. Intravenous contrast media administration is never needed in case of lung hernia



Explanation
a)     Thoracic CT with multiplanar image reconstructions (MPR) may be extremely useful for the assessment, localization and extent of a lung hernia [Although contrast enhanced computed tomography images CT scan is not necessary to diagnose symptomatic lung hernia, axial, sagittal and coronal image reconstructions may be of crucial importance because they better define the exact location and size of the chest wall defect, as well as the dimensions of the herniated lung tissue]

b)     Maximum intensity projection reformats (MIP) can detect cases of vascular occlusion or infarction and help exclude lung tissue strangulation  [Also, maximun intensity projection images (MIP) especially in axial, coronal and sagittal reformats, may be important in order to exclude strangulation of pulmonary tissue as well as infarction of pulmonary vessels]

c)    MinIP and not MIP reformats create a sort of ``bronchographic view`` of the lung by suppressing the pulmonary vasculature and imaging the bronchial tree herniated lung tissue and help exclude cases of bronchial tree compression. [Minimum intensity projection (MinIP) is a data visualization method that enables detection of low-density structures in a given volume. It is a particularly useful algorithm for analyzing the bronchial tree and may be helpful excluding bronchial occlusion regarding large and medium caliber bronchi]

d)    Contrast enhanced chest CT may help in cases where the hernia orifice is small and herniated lung tissue seems to be compressed. [In cases where the hernia orifice is of small diameter and the lung tissue appears really compressed (not in our case where the hernia orifice was wide) contrast enhanced chest CT must be performed (CT pulmonary angiogram protocol). Hence, the absence of contrast within the vessels of the herniated lung on contrast-enhanced CT can be taken as an indication of strangulation and therefore of imminently at-risk lung or already non-viable lung]

e)     VRT 3D images apart from being really impressive they provide a three-dimension overview of the lung herniation that is also useful for the surgical planning. [Volume rendered 3-dimensional reconstructions (VRT) provide an overview of the chest pathology and can be extremely useful for the assessment of the disease extent which is important for surgical planning]



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.




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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.






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