A lung hernia is a protrusion of lung tissue through an abnormal opening in the chest wall. It occurs in three primary categories: traumatic, pathologic, and spontaneous. Surgical repair is often needed for symptomatic hernias, but is not necessary for smaller defects.
Generally, lung hernias are benign and rarely cause problems. They are most commonly caused by rib fracture, trauma, or strenuous coughing. However, they can also occur as a result of congenital or acquired causes.
Traumatic lung hernias occur most often after injury to the chest region, such as a car accident. Acquired lung hernias are usually the result of a weakness or attenuation of the intercostal muscles or endothoracic fascia. Spontaneous hernias are extremely rare. They present with minor symptoms such as ecchymoses, coughing, and shortness of breath. Some of these hernias may be associated with pulmonary tuberculosis.
Patients with lung hernias should be referred to a pulmonologist or cardiothoracic surgeon. Lung hernias can be life threatening if left untreated. In addition to surgery, palliative measures are usually necessary. If the hernia is refractory to medical treatment, surgical intervention is required to ensure the best outcome.
Symptoms of a lung hernia can include coughing, shortness of breath, a lump in the neck, or difficulty breathing. Although most cases are benign, it is important to be aware of the symptoms of this condition to prevent unnecessary invasive procedures. The best way to diagnose the cause of a lung hernia is to perform a chest X-ray. Depending on the location of the defect, hernias can be diagnosed by lateral, apical, or intercostal.
The X-ray can also be used to diagnose the “lucent lung sign,” which is a bulge on the chest X-ray that is present even when the patient is not straining. If the bulge is located near the apex of the lung, it is most likely a lateral lung hernia. Symptoms can worsen with coughing and sneezing. Other presenting symptoms include fever, emphysema, and pneumothorax. Surgical treatment is recommended for patients with refractory symptoms, persistent pain, or a risk for severe complications.
Most pulmonary hernias are acquired and traumatic. Acquired hernias are generally associated with trauma, and may be triggered by strenuous coughing or strenuous lifting. Hernias that develop as a result of a sudden increase in intra-thoracic pressure can be life threatening.
Surgical treatment is necessary for a lung hernia if it is refractory to medical treatment or if the hernia is increasing in size. Surgical repair can also be necessary for recurrent infections and to correct a traumatic or congenital defect. This condition can be difficult to diagnose. Fortunately, most cases are discovered through diagnostic imaging, and a high-resolution chest CT scan is highly accurate.
A patient with a small apical lung hernia and subcutaneous emphysema could be treated with conservative management. In cases of larger hernias, surgery or a prosthetic patch are necessary. Steroids are sometimes prescribed for the treatment of a symptomatic lung hernia. Multiple courses of steroids can weaken the lungs and muscles and lead to muscular atrophy.
