Azat ÖZEL, Onur AKÇAY, Özgür ÖZTÜRK, Tuba ACAR, Soner GÜRSOY
Current Thoracic Surgery - 2026;11(1):100-104
Spontaneous lung herniation is a rare clinical entity caused by protrusion of lung tissue through a weakened chest wall in the absence of trauma. Due to its nonspecific presentation, diagnosis may be delayed or overlooked, particularly on initial imaging. We report the case of a 71-year-old obese male who presented with acute-onset right-sided chest pain following a severe coughing episode. Initial thoracic computed tomography revealed no significant pathology, and the patient was discharged with conservative treatment. Due to progression of symptoms, repeat imaging demonstrated a prominent lung herniation through the right 8th intercostal space, accompanied by minimal pleural effusion. Magnetic resonance imaging revealed a 9x1 cm intercostal defect. Surgical repair was performed via thoracotomy with reduction of the herniated lung tissue, approximation of the ribs, and reconstruction of the defect using a nonabsorbable polypropylene mesh. The postoperative course was uneventful, and the patient was discharged on postoperative day seven. This case highlights the diagnostic challenge of false-negative initial computed tomography and emphasizes the importance of repeat advanced imaging in patients with progressive symptoms. Spontaneous lung herniation should be considered in obese male patients presenting with localized chest pain and chest wall swelling following severe coughing. Initial imaging may fail to detect the condition, and repeat evaluation with computed tomography or magnetic resonance imaging is crucial in cases of clinical progression. Surgical repair is a safe and effective treatment option for symptomatic patients or those with large defects, leading to favorable outcomes and low recurrence rates.
