背景:肺外侧疝罕见,而肺疝仅在高能创伤的背景下报道。肺疝的好发部位是前胸。
方法:我们介绍一个82岁的男性,他因干咳入院,跌倒后呼吸短促和依赖呼吸的左侧胸痛。胸部X光检查提示肺炎,随后患者接受了抗生素治疗。由于12天后症状持续,进行了CT扫描,显示肋间肺疝无骨折。咨询了外科医生并建议进行手术干预。术中可以证实疝并切除坏死的肺组织。患者恢复良好,10天后出院,情况良好。
结论:胸内压突然升高时,肋间肌损伤导致肺组织突出。特别是外侧疝很少见,因为Serratus肌肉对胸壁进行了额外的外侧加固。虽然在无症状疝和小缺损尺寸的情况下,保守的方法是可能的,手术干预适用于较大的疝,肺组织可能嵌顿,导致梗塞和慢性疼痛或呼吸衰竭等症状。
结论:对于具有外伤病史和外部体征的胸痛的充分鉴别诊断,即使在低能量创伤后,也应在早期评估CT成像。对于较大的缺陷和持续的症状,需要进行手术。
BACKGROUND: Lateral lung hernias are rare, and a herniation of the lung is only reported in the context of high-energy trauma. The predilection site for lung hernias is the anterior thorax.
METHODS: We present the
case of a 82-year-old male, who was admitted with dry cough, shortness of breath and breath-dependent left-sided chest pain after a fall. Chest X-ray suggested a pneumonia and subsequently the patient was treated with antibiotics. Due to persistent symptoms after 12days a CT-scan was performed which showed an intercostal lung herniation without fractures. Surgeons were consulted and recommended an operative intervention. Intraoperatively the herniation could be confirmed and necrotic lung tissue was resected. The patient recovered well and was discharged after 10days in good general condition.
CONCLUSIONS: Herniation of lung tissue occurs as a result of injured intercostal muscles in a sudden increase of intrathoracic pressure. Especially
lateral herniation is rare because of the additional
lateral reinforcement of the thoracic wall by the Serratus muscle. While a conservative approach is possible in asymptomatic hernias and small defect size, surgical intervention is indicated for larger hernias, possible incarceration of lung tissue with resulting infarction and symptoms like chronic pain or respiratory failure.
CONCLUSIONS: For an adequate differential diagnosis of thoracic pain with a history and external signs of a trauma, a CT imaging should be evaluated at an early stage even after a low-energy trauma. An operation is indicated for large defect size and persistent symptoms.