71 male pleuritic chest pain

[pbruss]

Another rare finding I had that i wanted to share.

71 yo male come in with right sided CP, sharp, hruts when he breaths or moves, mild. Came on acuttley 3 days ago while coughing. 7 days ago he went to an urgent care care and placed on albuterol, steroids, and ABX. He has no doctor, denies any medical problems.

On exam he has tenderness on the right lateral side of the chest which is where he hurts. At the spot he has echymosis that extendes around to the anterior portion and covers the entire abdomen. Everythign else is with in normal limits and he is non-toxic apearing and in no respritory distress,

Attached is his CT scan.

Identify the abnormality and give the next step in treatment.

 

Attachments:

[kemple]

Looks like an intercostal lung hernia. Because he is symptomatic CT Sx consult for reduction and repair of the defect.

[pbruss]

correct, he had a cough induced intercostal lung herniation which is very rare. according to a paper by the Journal of the Royal Society of Medicine in 2010 "Most intercostal hernias involve penetrating or blunt abdominal injury, and so cough-induced abdominal intercostal hernia is a rare occurrence. To date, there are only seven cases described in the literature."


i called CT surgery at toledo who planned to take him to the ORl. if anyone needs a case to wirte up for your research let me know if you want to use this one.

[kemple]

That was a good case, I said to myself, man looks like a lung hernia, then Dr. Google took care of the rest and confirmed it. Thanks!