Spontaneous intercostal pulmonary hernia with subsegmental incarceration

Abstract

A case of acute intercostal pulmonary herniation due to vigorous coughing secondary to chronic bronchitis is reported in a 70-year-old male. Protruding pleura-covered lung tissue was found bulging through an intercostal space defect between the left midaxillary line and the infrasternal costochondral arch. A hernial sac consisting of parietal pleura and atrophic intercostal muscle confined a "sliding pouch" for two pulmonary segments of which one presented a demarcation zone of temporary incarceration interpreted as an entrapment of lung tissue between two ribs. A fracture gap was discovered affecting the anterior synostosis between ribs 7 and 8. Treatment was accomplished by anterior fixation of the ribs and by the basic principles of hernia repair between adjacent ribs. A case report and a brief survey of aetiological and anatomical classification is presented.