Under skin lung herniation

A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery 9 years ago presents with worsening dyspnea on exertion. He had a biopsy of the upper lobe of the left lung the week before. He was having a neoplastic mass evaluated. The patient presents with a soft left-sided anterior chest mass, inflating and deflating with respiration.

Vital signs: Respiratory rate 25 breaths/min, oxygen saturation 96% on room air; remaining vital signs within normal limits

General: Resting comfortably

Chest: Soft mass expanding and retracting above the left nipple

Labs within normal limits

This is an iatrogenic anterior chest wall lung herniation as a sequela of robotic coronary artery bypass grafting. This was chronic and unrelated to the patient presentation. The patient presented with dyspnea that was actually caused by another iatrogenic complication — pneumothorax from lung biopsy.

Lung herniation can be a rare complication in minimally invasive cardiothoracic surgery.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Harry Stark MD, MBS

Harry Stark MD, MBS

Emergency Medicine Resident
St. John's Riverside Hospital
Harry Stark MD, MBS

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