重度肺疝伴轻微创伤1例

Carvalho Am, Anderson Da
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A sharp tearing pain was reported at the initial injury which occurred while moving bricks 2 days prior. Several hours later, the patient, who is a smoker, had a coughing episode with aggravation of the pain and subsequent development of a soft spongy bulge at the site. The bulge increased in size with subsequent coughing and became severely painful, preventing normal tidal breaths. The patient reduced the swelling by external compression with a broad belt which he wore in order continue working. Although compression was helpful, he was unable to continue work due to intractable pain. On physical exam, the patient was alert and in no immediate distress. He had a 30 pack-year history of cigarette smoking but was otherwise in good health and used no medications. Vital signs were normal, except for a respiratory rate at 22/minute with shallow breaths. The patient was holding his right side and had a leather belt tightly bound over his upper abdomen. He was unable to take deep breaths, but there were decreased breath sounds over the right lateral and posterior lung fields. Once the belt was removed, there was no apparent swelling, but a depression was palpated at the lateral aspect between the eighth ninth rib interspace. The patient reported that he could replicate the bulge beneath the skin if he coughed. A chest x-ray showed an indistinct right basilar density with a potential small effusion possibly related to atelectasis or pneumonia (Figures 1A and 1B). There were no evident rib fractures. While preparing for a chest CT, the patient coughed, and the bulge recurred. CT images showed a large herniation of the right lower lobe between the 9th and 10th rib interspace. The adjacent ribs were separated with interruption of the associated intercostal muscles (Figures 2A and 2B, Figure 3 and Figure 4). The patient subsequently underwent a right thoracotomy with placement of a Gore-Tex patch to close the defect. A sterile seroma cavity had formed in the chest wall and was excised. The patient has recovered well and has not experienced further pain or recurrence of herniation on follow-up CT (Figure 5). Pulmonary herniation is a rare condition characterized by protrusion of the lung beyond the thoracic cavity. Less than 300 cases have been reported. Lung herniation is generally caused by increased Figure 1A. Admission chest X-ray, PA view showing a vague increased right basilar density thought to be a potential small effusion perhaps related to atelectasis or pneumonia Figure 1B. Admission chest X-ray, lateral view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 2-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Figure 2A. CT of chest, non-contrast, mediastinal windows. Axial view shows a large herniation of the right lower lobe between the eighth and ninth rib interspace and a chest wall defect. The intercostal muscles in this posterior lateral location are discontinuous over a broad area Figure 2B. CT of chest, non-contrast, lung windows, axial view at similar level as Figure 2A Figure 3. Chest CT, coronal view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 3-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Copyright: ©2018 Carvalho AM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Figure 4. Virtual reality images showing bronchial and vascular anatomy with extrusion through chest wall defect Figure 5. Chest CT, axial view, obtained after surgical repair of chest wall defect intrathoracic pressures with defects in the thoracic wall and is usually diagnosed following trauma or chest surgery [1]. Spontaneous lung herniation is rare and has been reported following coughing, sneezing, playing a wind instrument, or heavy lifting that may have caused damage to a rib or cartilage [2-4]. These events have been most common in males, particularly those that are smokers or are obese, such as the patient in this case. Not all defects require surgical repair. Indications for surgery include increasing size, pain, and potential incarceration of lung tissue. This patient likely ruptured muscle fibers during heavy lifting, with cough-induced herniation of a large section of lung tissue through the defect. References 1. Ishida A, Oki M, Saka H, Seki Y (2018) Postoperative intercostal lung hernia. Respirol Case Rep 6: e00323. [Crossref] 2. O’Shea M, Cleasby M (2012) Images in clinical medicine. Lung herniation after coughinduced rupture of intercostal muscle. N Engl J Med 366: 74. [Crossref] 3. Sulaiman A, Cottin V, De Souza Neto EP, Orsini A, Cordier JF, et al. (2006) Coughinduced intercostal lung herniation requiring surgery: Report of a case. Surg Today 36: 978-980. [Crossref] 4. Tack D, Wattiez A, Schtickzelle JC, Delcour C (2000) Spontaneous lung herniation after a single cough. Eur Radiol 10: 500-502. [Crossref]","PeriodicalId":11275,"journal":{"name":"Diagnostic imaging","volume":"5 1","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2018-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"A case of major lung herniation with minor trauma\",\"authors\":\"Carvalho Am, Anderson Da\",\"doi\":\"10.15761/RDI.1000140\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"We present a case of significant lung herniation which was related to a relatively low acuity injury sustained while moving a small load of bricks. The patient was symptomatic with pain and dyspnea, and chest images revealed a large herniation of the right lower lobe through a defect in the intercostal muscles. Lung herniation is rare but is usually associated with significant trauma or surgery. This degree of injury occurred with minor provocation but caused significant morbidity. *Correspondence to: Carvalho AM, Queen’s University Belfast School of Medicine, UK, E-mail: Paula.Carvalho@med.va.gov Received: June 15, 2018 Accepted: June 25, 2018; Published: June 28, 2018 Case report A 62-year-old man presented to the emergency room with swelling and pain at his right lower costal margin. A sharp tearing pain was reported at the initial injury which occurred while moving bricks 2 days prior. Several hours later, the patient, who is a smoker, had a coughing episode with aggravation of the pain and subsequent development of a soft spongy bulge at the site. The bulge increased in size with subsequent coughing and became severely painful, preventing normal tidal breaths. The patient reduced the swelling by external compression with a broad belt which he wore in order continue working. Although compression was helpful, he was unable to continue work due to intractable pain. On physical exam, the patient was alert and in no immediate distress. He had a 30 pack-year history of cigarette smoking but was otherwise in good health and used no medications. Vital signs were normal, except for a respiratory rate at 22/minute with shallow breaths. The patient was holding his right side and had a leather belt tightly bound over his upper abdomen. He was unable to take deep breaths, but there were decreased breath sounds over the right lateral and posterior lung fields. Once the belt was removed, there was no apparent swelling, but a depression was palpated at the lateral aspect between the eighth ninth rib interspace. The patient reported that he could replicate the bulge beneath the skin if he coughed. A chest x-ray showed an indistinct right basilar density with a potential small effusion possibly related to atelectasis or pneumonia (Figures 1A and 1B). There were no evident rib fractures. While preparing for a chest CT, the patient coughed, and the bulge recurred. CT images showed a large herniation of the right lower lobe between the 9th and 10th rib interspace. The adjacent ribs were separated with interruption of the associated intercostal muscles (Figures 2A and 2B, Figure 3 and Figure 4). The patient subsequently underwent a right thoracotomy with placement of a Gore-Tex patch to close the defect. A sterile seroma cavity had formed in the chest wall and was excised. The patient has recovered well and has not experienced further pain or recurrence of herniation on follow-up CT (Figure 5). Pulmonary herniation is a rare condition characterized by protrusion of the lung beyond the thoracic cavity. Less than 300 cases have been reported. Lung herniation is generally caused by increased Figure 1A. Admission chest X-ray, PA view showing a vague increased right basilar density thought to be a potential small effusion perhaps related to atelectasis or pneumonia Figure 1B. Admission chest X-ray, lateral view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 2-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Figure 2A. CT of chest, non-contrast, mediastinal windows. Axial view shows a large herniation of the right lower lobe between the eighth and ninth rib interspace and a chest wall defect. The intercostal muscles in this posterior lateral location are discontinuous over a broad area Figure 2B. CT of chest, non-contrast, lung windows, axial view at similar level as Figure 2A Figure 3. Chest CT, coronal view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 3-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Copyright: ©2018 Carvalho AM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Figure 4. Virtual reality images showing bronchial and vascular anatomy with extrusion through chest wall defect Figure 5. Chest CT, axial view, obtained after surgical repair of chest wall defect intrathoracic pressures with defects in the thoracic wall and is usually diagnosed following trauma or chest surgery [1]. Spontaneous lung herniation is rare and has been reported following coughing, sneezing, playing a wind instrument, or heavy lifting that may have caused damage to a rib or cartilage [2-4]. These events have been most common in males, particularly those that are smokers or are obese, such as the patient in this case. Not all defects require surgical repair. Indications for surgery include increasing size, pain, and potential incarceration of lung tissue. This patient likely ruptured muscle fibers during heavy lifting, with cough-induced herniation of a large section of lung tissue through the defect. References 1. Ishida A, Oki M, Saka H, Seki Y (2018) Postoperative intercostal lung hernia. Respirol Case Rep 6: e00323. [Crossref] 2. O’Shea M, Cleasby M (2012) Images in clinical medicine. Lung herniation after coughinduced rupture of intercostal muscle. N Engl J Med 366: 74. [Crossref] 3. Sulaiman A, Cottin V, De Souza Neto EP, Orsini A, Cordier JF, et al. (2006) Coughinduced intercostal lung herniation requiring surgery: Report of a case. Surg Today 36: 978-980. [Crossref] 4. Tack D, Wattiez A, Schtickzelle JC, Delcour C (2000) Spontaneous lung herniation after a single cough. Eur Radiol 10: 500-502. 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引用次数: 0

摘要

我们提出了一个明显的肺疝的情况下,这是一个相对较低的锐锐度损伤持续,而移动一小负荷的砖。患者的症状是疼痛和呼吸困难,胸部图像显示右下叶通过肋间肌缺损有很大的突出。肺疝是罕见的,但通常与重大创伤或手术有关。这种程度的损伤发生在轻微的刺激下,但引起了显著的发病率。*通讯:Carvalho AM, Queen 's University Belfast School of Medicine, UK, E-mail: Paula.Carvalho@med.va.gov收稿日期:2018年6月15日;病例报告一名62岁男性因右下肋缘肿胀和疼痛而被送往急诊室。据报道,在2天前搬砖时出现了尖锐的撕裂性疼痛。几小时后,患者(吸烟者)咳嗽,疼痛加重,随后在该部位出现柔软的海绵状隆起。随着随后的咳嗽,肿胀增大,并变得严重疼痛,妨碍了正常的潮汐呼吸。病人用一条宽腰带进行外压,减轻了肿胀,以便继续工作。尽管压迫有帮助,但由于顽固性疼痛,他无法继续工作。经体格检查,病人神志清醒,没有立即出现痛苦。他有30包年的吸烟史,但健康状况良好,没有使用任何药物。生命体征正常,呼吸频率为22/分钟,呼吸浅。病人捂着自己的右侧身体,一条皮带紧紧地绑在他的上腹部。他不能深呼吸,但右外侧和后肺野呼吸音减弱。一旦皮带被移除,没有明显的肿胀,但在第八,第九肋骨间隙之间的侧面触诊到一个凹陷。病人报告说,如果他咳嗽,他可以复制皮肤下的隆起。胸部x线显示右侧基底动脉密度不明显,有可能与肺不张或肺炎有关的少量积液(图1A和1B)。没有明显的肋骨骨折。在准备胸部CT时,患者咳嗽,肿块复发。CT图像显示右下叶在第9和第10肋间隙间有一大块突出。相邻肋骨被分开,相关肋间肌被打断(图2A和2B,图3和图4)。患者随后行右开胸术,放置Gore-Tex补片以闭合缺损。胸壁形成无菌浆液腔并切除。患者恢复良好,随访CT未见进一步疼痛或疝复发(图5)。肺疝是一种罕见的疾病,其特征是肺突出至胸腔外。目前报告的病例不到300例。肺疝一般由图1A增高引起。入院胸部x线,PA片显示右基底动脉密度模糊增加,认为可能与肺不张或肺炎有关的潜在小积液。Carvalho AM(2018)重型肺疝合并轻微创伤1例放射诊断与影像杂志,2018 doi: 10.15761/RDI.1000140图2 a。胸部CT,无对比,纵隔窗。轴位片显示右下肺叶在第8和第9肋间隙间有很大的突出和胸壁缺损。后外侧肋间肌在大范围内不连续(图2B)。胸部CT,无对比,肺窗,轴位位与图2A相似。Carvalho AM(2018)重型肺疝合并轻微创伤1例放射诊断与影像杂志,2018 doi: 10.15761/RDI.1000140版权所有:©2018 Carvalho AM。这是一篇根据知识共享署名许可协议发布的开放获取文章,该协议允许在任何媒体上不受限制地使用、分发和复制,前提是要注明原作者和来源。图4。虚拟现实图像显示支气管和血管解剖与挤压通过胸壁缺陷图5。胸部CT,轴位图,胸壁缺损手术修复后获得胸壁缺损胸内压力,通常在创伤或胸外科手术后诊断[1]。自发性肺疝是罕见的,据报道,在咳嗽、打喷嚏、吹奏管乐器或举重可能造成肋骨或软骨损伤后发生[2-4]。这些事件在男性中最为常见,尤其是那些吸烟或肥胖的人,比如这个病例中的病人。并非所有的缺陷都需要手术修复。 手术适应症包括肺组织体积增大、疼痛和潜在的嵌顿。该患者可能在举重时肌肉纤维破裂,咳嗽引起的肺组织大面积疝出。引用1。石田,王晓明,王晓明(2018)术后肺肋间疝。呼吸素病例报告6:e00323。(Crossref) 2。O’shea M, Cleasby M(2012)临床医学图像。咳嗽所致肋间肌破裂后肺疝。中华医学杂志366:74。(Crossref) 3。Sulaiman A, Cottin V, De Souza Neto EP, Orsini A, Cordier JF等。(2006)咳嗽致肋间肺疝需手术治疗1例。今日外科36:978-980。(Crossref) 4。张建军,张建军,张建军,等(2000)原发性肺疝的临床观察。eurradiol 10:50 -502。(Crossref)
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case of major lung herniation with minor trauma
We present a case of significant lung herniation which was related to a relatively low acuity injury sustained while moving a small load of bricks. The patient was symptomatic with pain and dyspnea, and chest images revealed a large herniation of the right lower lobe through a defect in the intercostal muscles. Lung herniation is rare but is usually associated with significant trauma or surgery. This degree of injury occurred with minor provocation but caused significant morbidity. *Correspondence to: Carvalho AM, Queen’s University Belfast School of Medicine, UK, E-mail: Paula.Carvalho@med.va.gov Received: June 15, 2018 Accepted: June 25, 2018; Published: June 28, 2018 Case report A 62-year-old man presented to the emergency room with swelling and pain at his right lower costal margin. A sharp tearing pain was reported at the initial injury which occurred while moving bricks 2 days prior. Several hours later, the patient, who is a smoker, had a coughing episode with aggravation of the pain and subsequent development of a soft spongy bulge at the site. The bulge increased in size with subsequent coughing and became severely painful, preventing normal tidal breaths. The patient reduced the swelling by external compression with a broad belt which he wore in order continue working. Although compression was helpful, he was unable to continue work due to intractable pain. On physical exam, the patient was alert and in no immediate distress. He had a 30 pack-year history of cigarette smoking but was otherwise in good health and used no medications. Vital signs were normal, except for a respiratory rate at 22/minute with shallow breaths. The patient was holding his right side and had a leather belt tightly bound over his upper abdomen. He was unable to take deep breaths, but there were decreased breath sounds over the right lateral and posterior lung fields. Once the belt was removed, there was no apparent swelling, but a depression was palpated at the lateral aspect between the eighth ninth rib interspace. The patient reported that he could replicate the bulge beneath the skin if he coughed. A chest x-ray showed an indistinct right basilar density with a potential small effusion possibly related to atelectasis or pneumonia (Figures 1A and 1B). There were no evident rib fractures. While preparing for a chest CT, the patient coughed, and the bulge recurred. CT images showed a large herniation of the right lower lobe between the 9th and 10th rib interspace. The adjacent ribs were separated with interruption of the associated intercostal muscles (Figures 2A and 2B, Figure 3 and Figure 4). The patient subsequently underwent a right thoracotomy with placement of a Gore-Tex patch to close the defect. A sterile seroma cavity had formed in the chest wall and was excised. The patient has recovered well and has not experienced further pain or recurrence of herniation on follow-up CT (Figure 5). Pulmonary herniation is a rare condition characterized by protrusion of the lung beyond the thoracic cavity. Less than 300 cases have been reported. Lung herniation is generally caused by increased Figure 1A. Admission chest X-ray, PA view showing a vague increased right basilar density thought to be a potential small effusion perhaps related to atelectasis or pneumonia Figure 1B. Admission chest X-ray, lateral view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 2-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Figure 2A. CT of chest, non-contrast, mediastinal windows. Axial view shows a large herniation of the right lower lobe between the eighth and ninth rib interspace and a chest wall defect. The intercostal muscles in this posterior lateral location are discontinuous over a broad area Figure 2B. CT of chest, non-contrast, lung windows, axial view at similar level as Figure 2A Figure 3. Chest CT, coronal view Carvalho AM (2018) A case of major lung herniation with minor trauma Volume 2(4): 3-3 Radiol Diagn Imaging, 2018 doi: 10.15761/RDI.1000140 Copyright: ©2018 Carvalho AM. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Figure 4. Virtual reality images showing bronchial and vascular anatomy with extrusion through chest wall defect Figure 5. Chest CT, axial view, obtained after surgical repair of chest wall defect intrathoracic pressures with defects in the thoracic wall and is usually diagnosed following trauma or chest surgery [1]. Spontaneous lung herniation is rare and has been reported following coughing, sneezing, playing a wind instrument, or heavy lifting that may have caused damage to a rib or cartilage [2-4]. These events have been most common in males, particularly those that are smokers or are obese, such as the patient in this case. Not all defects require surgical repair. Indications for surgery include increasing size, pain, and potential incarceration of lung tissue. This patient likely ruptured muscle fibers during heavy lifting, with cough-induced herniation of a large section of lung tissue through the defect. References 1. Ishida A, Oki M, Saka H, Seki Y (2018) Postoperative intercostal lung hernia. Respirol Case Rep 6: e00323. [Crossref] 2. O’Shea M, Cleasby M (2012) Images in clinical medicine. Lung herniation after coughinduced rupture of intercostal muscle. N Engl J Med 366: 74. [Crossref] 3. Sulaiman A, Cottin V, De Souza Neto EP, Orsini A, Cordier JF, et al. (2006) Coughinduced intercostal lung herniation requiring surgery: Report of a case. Surg Today 36: 978-980. [Crossref] 4. Tack D, Wattiez A, Schtickzelle JC, Delcour C (2000) Spontaneous lung herniation after a single cough. Eur Radiol 10: 500-502. [Crossref]
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