CTICasesTranscostal Lung Herniation with Localized Parenchymal Fibrosis
Imaging findings
High-resolution chest CT on inspiration and expiration demonstrates thinned intercostal and serratus anterior muscles with bilateral, symmetric transcostal lung herniation. Associated with the herniated lung segments are coarse, localized parenchymal reticular opacities and pleural thickening, representing traction-related mechanical fibrosis from chronic rubbing against the rib margins.
Key takeaways
Chronic or recurrent transcostal lung herniation can lead to a highly localized, coarse form of parenchymal and pleural fibrosis restricted strictly to the herniating lung. This localized reaction is caused by repetitive mechanical friction and sliding of the lung parenchyma over the osseous and muscular margins of the chest wall defect.
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