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Case Reports
. 2018 Jun 22;10(6):e2861.
doi: 10.7759/cureus.2861.

Spontaneous Lung Herniation Leading to Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumopericardium

Mohsin Hamid  1 , Ali R Ghani  1 , Waqas Ullah  1 , Usman Sarwar  1 , Rajesh Patel  2
Affiliations
Case Reports

Spontaneous Lung Herniation Leading to Extensive Subcutaneous Emphysema, Pneumothorax, Pneumomediastinum, and Pneumopericardium

Mohsin Hamid et al. Cureus. .

Abstract

Spontaneous lung herniation is a rare phenomenon in which the lung parenchyma along with the pleural membranes protrudes outside their usual boundaries and can lead to a wide variety of complications. We are reporting a case of a middle-aged male who presented with chronic obstructive pulmonary disease (COPD) exacerbation with severe bouts of cough. Initial computed tomography (CT) chest was unrevealing, but two days later, he developed spontaneous lung herniation, which was initially managed conservatively, but later it progressed to pneumothorax, pneumomediastinum, with striking CT scan images showing extensive subcutaneous emphysema. Blowhole incisions were done on the anterior chest wall which led to ultimate recovery.

Keywords: blow-hole incisions; diaphragmatic hernia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. CT chest axial view showing a small portion of the right lung herniating through the right posterolateral seventh and eighth rib space (arrow) with mild subcutaneous emphysema (arrowhead)
CT: computed tomography
Figure 2
Figure 2. CT chest axial view showing large right-sided pneumothorax (yellow arrow) with extensive subcutaneous air (green arrowheads) throughout the thorax
CT: computed tomography
Figure 3
Figure 3. CT chest coronal section showing right-sided pneumothorax (yellow arrow) at the site of the previous herniation with extensive subcutaneous emphysema (green arrowhead), pneumomediastinum (yellow star), and pneumopericardium (green arrow)
CT: computed tomography
Figure 4
Figure 4. CT neck coronal section showing extensive subcutaneous emphysema (green arrowheads) involving the face, neck, and chest; narrowing of the oropharynx due to extensive air in the prevertebral space and retropharyngeal space is also present (yellow arrow)
CT: computed tomography
Figure 5
Figure 5. CT chest coronal view showing persistent lung herniation and splaying of ribs (yellow arrow)
CT: computed tomography
See this image and copyright information in PMC

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