Lung herniation through a postthoracoscopy chest wall defect - Demonstration with spiral CT

Department of Medical Radiology, Zurich University Hospital, Switzerland.
Chest (Impact Factor: 7.48). 09/1997; 112(2):558-60. DOI: 10.1378/chest.112.2.558
Source: PubMed


The incidence of complications following thoracoscopy is approximately 10%, the most prevalent being prolonged air leak and chest pain. We report two cases of lung herniation through the chest wall defect created by thoracoscopy. Use of the Valsalva maneuver during CT scanning is recommended as a diagnostic imaging method in cases with suspected lung herniation.

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Available from: Markus Hauser, Mar 11, 2014
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    • "Iatrogenic postoperative lung hernias are commonly reported anteriorly after less extensive surgical procedures, such as thoracoscopy [10] "
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    ABSTRACT: Lung herniation, defined as a protrusion of the lung parenchyma with pleural membranes through a defect of the thoracic wall, is a rare entity. As minimally invasive cardiac procedures evolve, different complications may be evident such as lung herniation. A retrospective review of all patients submitted to minimally invasive cardiac or transplant surgery through anterior mini-thoracotomy at our department revealed 16 patients with lung herniation and this experience is analyzed. From 1996 through 2007, 12 male (75%) and 4 female ranging in age between 23 and 77 years submitted prior either to minimally invasive cardiac or transplant surgery were admitted at our department for a lung hernia. The location was right in eight cases, left in six, and in two cases the herniation was bilateral. The majority of our patients were symptomatic. Twelve of them (75%) complained of pain. The bulge was present regardless of straining. Diagnosis was confirmed by chest X-ray and tomographic scan in all of them. The surgical procedure included identification of the hernial sac and reconstruction of the defect. A variety of materials were used for chest wall reconstruction such as Vicryl and Goretex mesh. There was no perioperative mortality or morbidity. Patients were discharged within 5-7 days postoperatively and in a follow up of 3 months to 8 years no recurrence was observed. (1) Since the thoracic cage has inherent weakness anteriorly near the sternum, attention is needed when the anterior approach is used. (2) Hernias with persistent pain and entrapped lung usually need reconstruction with a patch in order to avoid late complications such as recurrent pulmonary infections and hemoptysis due to strangulation.
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