CTICasesCough-Induced Transcostal Lung Herniation
Imaging findings
CT chest shows a large herniation of the right lower lobe lung parenchyma through a wide separation of the ribs into the chest wall, accompanied by protrusion of a portion of the liver. There is tearing of the intercostal muscles and an associated rib fracture.
Key takeaways
Severe coughing spells can generate extreme intrathoracic pressures, leading to intercostal muscle tears, rib fractures, and acquired transcostal lung herniation. This typically occurs in the anterior or lateral chest wall where support is weaker, and may require surgical repair if symptomatic or if abdominal contents (like the liver) herniate.
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