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• W2895526376 abstract "SESSION TITLE: Surgery cases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 04:45 PM - 05:45 PM INTRODUCTION: Chest wall hernia is a rare diagnosis and previously there had only been about 300 cases reported. Spontaneous posterior chest wall hernias are even less common. CASE PRESENTATION: A 66 year old male with history of coronary artery disease and hypertension presented to the clinic with a chief complaint of six weeks of cough. His cough was non-productive and worse at night. He developed severe lateral rib pain on the left, denying any inciting trauma or falls. His pain became so great that he would strap a belt around his ribs to help reduce the pain from coughing. He decided to present to an outside hospital where he was hospitalized for pneumonia and treated with antibiotics. On exam the patient had normal lung sounds and tenderness over the left lateral lower chest wall, but no masses or defects of the chest wall. The patient’s cough had been improving and the plan was to observe. At follow-up four weeks later, the patient’s cough had completely resolved and his pain was improved; however, the patient stated that he had a small bulge in his chest wall. After a CT scan a month later, the patient complained that the protrusion was now larger and changing with respiration. On examination there was no erythema, tenderness, or skin change. He had a reducible mass that would slide back in over the rib and then recur with the next exhalation. CT scan showed that patient had sub-acute fractures of the 7th, 8th and 9th ribs and had developed a herniation of the lung through the left 8th and 9th ribs. The patient ultimately underwent thoracotomy with dissection of the affected rib space. The lung was reduced and a Gore-tex mesh was inserted to close the defect. He has recovered without complication. DISCUSSION: Chest wall hernias are rare. They were first classified by Morel-Lavalle in 1845 where he grouped them by cause and location. Lung hernias have been described as congenital or acquired. Most acquired cases are due to trauma or post-surgical complications, though spontaneous or atraumatic chest wall hernias have also been described. A case series by Brock et al attributed spontaneous lung hernia to a sudden increase in thoracic pressure caused by vigorous cough or sneeze. This may cause a defect in the thoracic wall and can include rib fractures. Surgical management is typical for symptomatic cases, however some advocate for simple observation in small or supraclavicular hernias. Surgical techniques for repair include figure eight suture repair, use of autologous tissue, or insertion of a mesh to maintain chest wall continuity. Given the rarity of the diagnosis, the etiologies of the defect and various patient comorbidities, an individualized approach should be taken for each patient. CONCLUSIONS: Violent coughing fits can rarely result in chest wall hernias and management should be individualized, but often including surgical repair. Reference #1: Seder, C. W., Allen, M. S., Nichols, F. C., Wigle, D. A., Shen, K. R., Deschamps, C., et al. (2014). Primary and prosthetic repair of acquired chest wall hernias: A 20-year experience. The Annals of Thoracic Surgery, 98(2), 484-489. Reference #2: Jastrow, K. M.,3rd, Chu, D., Jaroszewski, D., Huh, J., & Bakaeen, F. (2009). Posterior lung herniation after a coughing spell: A case report. Cases Journal, 2(1), 86-1626-2-86. Reference #3: Brock, M. V., & Heitmiller, R. F. (2000). Spontaneous anterior thoracic lung hernias. The Journal of Thoracic and Cardiovascular Surgery, 119(5), 1046-1047. DISCLOSURES: No relevant relationships by Rorak Hooten, source=Web Response No relevant relationships by Peter Murphy, source=Web Response" @default.
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• W2895526376 title "A CASE OF SPONTANEOUS CHEST WELL HERNIA DUE TO VIOLENT COUGH" @default.
• W2895526376 doi "https://doi.org/10.1016/j.chest.2018.08.042" @default.
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