Acquired intercostal lung herniation: conservative management may lead to continuation of symptoms and other adverse consequence

  • Brent Berry
  • Dana Ghazaleh
  • Reem Matar
  • Azizullah Beran
  • James Risser
  • Bryan J. Warren
  • Malik GhannamEmail author
Case Report



It is quite rare for lung to herniate between a patient’s ribs, most often seen after surgery; it is, however, also rarely seen in other situations, notably during coughing fits situations such as coughing spells. There is minor controversy in the literature regarding management, namely, a question of whether to manage conservatively or with surgical correction, since this is such a rare entity physicians, may face difficulty in knowing how to proceed. Here, we provide evidence supporting acquired lung herniation management to be repaired surgically, and early, while at the same time medically optimizing the patient’s risk factors for further herniation events or intercostal muscle tears.


We report a 79-year-old man who suffered a right-sided lung herniation as a result of vigorous coughing, he initially was managed conservatively, and symptoms worsened but then underwent surgical repair which was associated with a suitable outcome.


Lung herniation will may resolve on its own and prompt correction should be considered instead of conservative management. We recommend early surgical repair for all intercostal lung herniations, even if they are asymptomatic, to prevent complications or extension of the defect into the abdominal wall. Surgery may offer the best results, with low morbidity and no mortality reported to date.


Lung herniation Surgical treatment vs conservative treatment Vigorous coughing 



Chronic obstructive pulmonary disease


Diffusion capacity of the lungs for carbon monoxide


Forced expiratory volume in the first second


Posterior anterior chest X-ray


Gastroesophageal reflux disease


Endotracheal tube



The authors thank the patient who generously agreed to participate in this medical report.

Author contributions

JR, BW, MG, and BB were responsible for the clinical management of the patient. AB, RM, and DG were responsible of drafting and editing of the manuscript. All authors: critical revision of the manuscript for important intellectual content, read, and approved the final manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Availability of data and materials

All the data supporting our findings is contained within manuscript.

Consent for publication

Written informed consent was obtained from the patient for publication of this case report and any accompanying images.

Ethics approval and consent to participate

Ethics committee approval was not applicable as the information was analyzed in a retrospective manner and had no effect on treatment.


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Copyright information

© The Japanese Association for Thoracic Surgery 2019

Authors and Affiliations

  • Brent Berry
    • 1
  • Dana Ghazaleh
    • 2
    • 3
  • Reem Matar
    • 4
  • Azizullah Beran
    • 4
  • James Risser
    • 5
  • Bryan J. Warren
    • 5
  • Malik Ghannam
    • 1
    Email author
  1. 1.Department of NeurologyUniversity of MinnesotaMinneapolisUSA
  2. 2.An-Najah National UniversityNablusPalestine
  3. 3.University of MinnesotaMinneapolisUSA
  4. 4.Department of Gastroenterology and HepatologyMayo ClinicRochesterUSA
  5. 5.Department of Hospital Medicine/HealthPartnersSt. PaulUSA

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