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S
Chest Wall Hernias Michael C. Smith
Kings County Hospital
October 23, 2014
Case Presentation
64 year old male presents to clinic with
bulging in right anterior chest wall for
roughly one year associated which varies
with respiration, causing pain.
History
S PMH: HTN, HLD, CAD, CHF, DM, OSA, COPD
S PSH: Right VATS for Thymoma
S All: NKDA
S Meds: Amlodipine, Losartan, ASA, Isosorbide Dinitrate,
Coreg, Crestor, Spironolactone, Lasix
S Social: 20 pack-year Smoker (Quit 1998)
Physical Exam
S Vital Signs normal
S Multiple scars in right chest consistent with surgical
history
S Soft bulge in right anterior chest best appreciated with
Valsalva Maneuver
Imaging
Imaging
Operation
SRepair of Chest Wall Hernia with
Gore-Tex Mesh
SOR Time 1:45
S EBL 25 cc
S Fluid 1200 cc
Operation
2nd
Rib Lung
4th Rib
Operation
Operation
Operation
Operation
Postoperative Course
S Extubated in OR
S Chest XR performed in PACU – no pneumothorax
S Discharged home POD #0
S Seen in clinic on POD #8, asymptomatic
Questions?
S
Chest Wall Hernias Michael C. Smith
Kings County Hospital
October 23, 2014
SCORE
History
S First described in 1499 by Roland
History
S American Civil War: 3 cases
S South African Civil War: 1 case
S World War II: 11 cases
Classification
Morel-Lavelle, 1845
S Location:
S Cervical
S Thoracic
S Diaphragmatic
S Etiology:
S Congenital
S Acquired
Diagnosis
S History
S Bulging Mass
S Increases with Coughing/Valsalva
S History of trauma, surgery, or repeated coughing
S Symptoms variable
S Physical
S Soft mass with crepitus
S Varies with breathing/Valsalva
Differential Diagnosis
SNeoplasms
SAbscess
SSubcutaneous Emphysema
Imaging
Imaging
Imaging
Imaging
Operative Techniques
Operative Techniques
Operative Techniques
Operative Techniques
Operative Techniques
Types of Mesh
Types of Mesh
Biomaterials
Biomaterials
Biomaterials
Biomaterials
Soft Tissue Flaps
Muscle Artery Use
Latissimus Dorsi Thoracodorsal Anterior/Lateral
Pectoralis Major Thoracoacromial Anterior/Midline
Serratus Anterior Lateral Thoracic Lateral
Rectus Abdominus Superior Epigastric Anterior/Midline
Omentum Gastroepiploic Midline
Questions?
References
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Dept. of the Army.
Detorakis, E. E., & Androulidakis, E. (2014). Intercostal Lung Herniation - The Role of Imaging. Journal of Radiology Case Reports, 8(4), 16-24.
doi: 10.3941/jrcr.v8i4.1606
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Miller, D. L., Force, S. D., Pickens, A., Fernandez, F. G., Luu, T., & Mansour, K. A. (2013). Chest Wall Reconstruction Using Biomaterials.
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Munnell, E. R. (1968). Herniation of the Lung. The Annals of Thoracic Surgery, 5(3), 204-212. doi: 10.1016/S0003-4975(10)66333-3
Reardon, M. J., Fabré, J., Reardon, P. R., & Baldwin, J. C. (1998). Video-Assisted Repair of a Traumatic Intercostal Pulmonary Hernia. The
Annals of Thoracic Surgery, 65(4), 1155-1157. doi: 10.1016/S0003-4975(98)00035-6
Shields, T. W. (2005). General thoracic surgery. Philadelphia: Lippincott Williams & Wilkins.
Zardo, P., Zhang, R., Freermann, S., & Fischer, S. (2014). Properties of Novel Composite Meshes in Chest Wall Reconstruction: A
Comparative Animal Study. Annals of Thoracic Medicine, 9(3), 158-161. doi: 10.4103/1817-1737.134071