Current Thoracic Surgery
2026 , Vol 11 , Issue 1
Cough-induced spontaneous intercostal lung herniation: a case report
1Department of Thoracic Surgery, Bakircay University, Cigli Training and Research Hospital, İzmir, Türkiye
DOI :
10.26663/cts.2026.013
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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.
Keywords :
spontaneous lung herniation, intercostal, cough-induced chest wall defect