PMC4872471_01
This photograph shows a large subcutaneous ecchymosis on the patient's left lateral thorax before surgery.
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Clinical examination revealed a large, painful left-sided ecchymosis on the level of the 9th rib (Fig. 1).
The chest X-ray on admission shows a left basal transparency reduction (blue arrow).
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CRP of 16 mg/l. Conventional chest X-ray showed a left-basal opacification, without evidence of pleural effusion, pneumothorax or bony injuries. (Fig. 2) At the time the patient's symptoms were interpreted as a left-sided pneumonia, and the patient was treated with antibiotics for a total of 10 days.
The CT-scan on the 12th day following admission reveals a herniation of the lung through the left lateral chest wall between the 8th and 9th rib (blue arrow).
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This intraoperative photograph shows the intercostal gap (*) between the 8th and the 9th rib (C).
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A haematoma between the chest-wall muscles and ribs and a 5 cm long rupture of the intercostal muscles without any rib fractures or sternal lesions (Fig. 4) were identified.
This intraoperative photograph shows the herniated lung tissue (H) prolapsing through the intercostal gap (*) between the 8th and the 9th rib (C).
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In the 8th intercostal space a herniated necrotic part of the left lower lung lobe was found. (Fig. 5) The existing intercostal opening was enlarged to explore the left pleural space and a wedge resection of the necrotic lung segment using a staple device was performed.