Lung Hernia

General Considerations

• Rare
• Protrusion of lung covered by both parietal and visceral pleurae through an abnormal opening in the thoracic wall
• Most are acquired and traumatic
• Usually due to motor vehicle accident, prior chest tube insertion or coughing and rib fracture
• Other causes
• Congenital, due to developmental defects in the chest wall
• Most frequently in the supraclavicular fossa or the anterior chest wall
• In adults, cervical lung hernias are acquired, especially in older persons with chronic coughs and/or emphysema or in weight-lifters or those who play wind instruments
• Care must be exercised in inserting a central venous catheter in such people
• Secondary to infectious (e.g., TB) or neoplastic disease of the chest wall
• Post-traumatic intercostal hernias may not appear for months or years after the trauma

Clinical Findings

• Most are asymptomatic
• Palpable, soft, crepitant  intercostal mass which may expand in size on inspiration or with Valsalva
• CT is more helpful in showing the origin and size of the hernia

Imaging Findings

• Lung tissue protruding outside of the thoracic cage
• May be missed on radiographs unless beam is tangential to the hernia

Treatment

• Congenital cervical hernias almost always resolve spontaneously
• Usually conservative treatment is sufficient
• If the hernia is large or lung becomes strangulated, surgery may be required

 Lung Hernia. There is protrusion of lung outside the thoracic cage (black arrows), This is an acquired, post-traumatic lesion caused by the previous insertion of a chest tube.

Hernia of the Lung Through the Anterior Chest Wall. M Shameema,  T Saada, R Bhargavaa, Z Ahmeda, DK Pandeya, and N

Lung Hernia: Radiographic Features. M Bhalla, BS Leitman, C Forcade, E Stern, DP Naidich and  DI McCauley. AJR. Jan 1990, Vol 154, No 1. 51-53.