Lateral lung hernia following a low-energy trauma without bony injuries: A case report

INTRODUCTION: Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax. PRESENTATION OF CASE: We present the case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall. Chest X-ray suggested a pneumonia and subsequently the patient was treated with antibiotics. Due to persistent symptoms after 12 days a CT-scan was performed which showed an intercostal lung herniation without fractures. Surgeons were consulted and recommended an operative intervention. Intraoperatively the herniation could be confirmed and necrotic lung tissue was resected. The patient recovered well and was discharged after 10 days in good general condition. DISCUSSION: Herniation of lung tissue occurs as a result of injured intercostal muscles in a sudden increase of intrathoracic pressure. Especially lateral herniation is rare because of the additional lateral reinforcement of the thoracic wall by the Serratus muscle. While a conservative approach is possible in asymptomatic hernias and small defect size, surgical intervention is indicated for larger hernias, possible incarceration of lung tissue with resulting infarction and symptoms like chronic pain or respiratory failure. CONCLUSION: For an adequate differential diagnosis of thoracic pain with a history and external signs of a trauma, a CT imaging should be evaluated at an early stage even after a low-energy trauma. An operation is indicated for large defect size and persistent symptoms.