Herniation of the lung: a case report.

BACKGROUND: Chest pain accounts for a significant number of visits to the Emergency Department. Lung herniation is an uncommon cause of chest pain, but one that is easily treated. Patients may complain of pain or present with ecchymosis or a visible bulge in the chest wall. Most lung herniations are located anteriorly or at the thoracic inlet, due to the lack of musculature in these areas. We present a unique case of a right lateral lung herniation and subsequent development of a spontaneous right-sided transdiaphragmatic hernia.
OBJECTIVES: To discuss the presentation of a patient found to have a spontaneous lung and bowel herniation, and to review the literature regarding these entities. CASE REPORT: A 61-year old gentleman with a history of chronic obstructive pulmonary disease and previous long-standing smoking history presented with complaints of right-sided chest pain and cough. He was found to have a spontaneous right lateral lung herniation. This was managed expectantly, but the patient subsequently developed spontaneous right-sided diaphragmatic rupture and herniation of bowel contents through the chest wall.
CONCLUSION: To our knowledge, this is the first reported case of a patient presenting with spontaneous right-sided lateral lung herniation and spontaneous right-sided transdiaphragmatic hernia. This case is unusual given the location of the hernias, and is unique in the spontaneous development of the hernias without any inciting history of trauma.