IMAGES IN CARDIOTHORACIC MEDICINE AND SURGERY |
Large Pulmonary Hernia following Thoracotomy
Christian O Ritter, MD,
Markus Weininger, MD,
Dietbert Hahn, MD,
Matthias Beissert, MD
Institute of Radiodiagnostics Bayerischen Julius-Maximilians University Clinic Wuerzburg, Germany
Christian O Ritter, MD, Tel: +49 931 201 34225, Fax: +49 931 201 61855, Email: ritter{at}roentgen.uni-wuerzburg.de, Institut fuer Roentgendiagnostik, ZOM, Oberduerrbacherstrasse 6, 97080 Wuerzburg, Germany.
A 60-year-old man with history of bilateral thoracotomies due to bronchial carcinoma and pulmonary metastases of prostate carcinoma was admitted for follow-up chest radiography (Figure 1
). Clinical examination revealed a palpable lump under the left thoracotomy scar, changing in size. Chest radiography and additional computed tomography (Figure 2) showed a large pulmonary hernia.
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Figure 1. Postoperative chest radiograph demonstrating lung herniation at the left chest wall (arrow), and displacement of the lateral portions of several left ribs (arrow heads). Slight blunting of the left costophrenic angle (*) is consistent with pleural thickening.
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Figure 2. (A) Transverse computed tomography of the thorax, showing a defect in the 4th intercostal space of the left chest wall, with bulging of the upper lobe of the left lung (black arrow; lung window settings). Note the vessel leading into the pulmonary hernia (white arrow). (B) In coronal reconstruction, the pulmonary hernia measured 65 x 50 mm in size during inspiration. The hernia was covered by a thin layer of parietal pleura only, reaching directly under the skin. (C) The white arrow indicates one of several rib fractures with pseudarthrosis (bone window settings).
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Asian Cardiovasc Thorac Ann 2009;
17:535-536
© 2009 by SAGE Publications
DOI: 10.1177/0218492309348627
