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S
Chest Wall Hernias Michael C. Smith
Kings County Hospital
October 23, 2014
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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.
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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)
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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
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Imaging
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Imaging
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Operation
SRepair of Chest Wall Hernia with
Gore-Tex Mesh
SOR Time 1:45
S EBL 25 cc
S Fluid 1200 cc
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Operation
2nd
Rib Lung
4th Rib
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Operation
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Operation
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Operation
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Operation
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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
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Questions?
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S
Chest Wall Hernias Michael C. Smith
Kings County Hospital
October 23, 2014
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SCORE
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History
S First described in 1499 by Roland
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History
S American Civil War: 3 cases
S South African Civil War: 1 case
S World War II: 11 cases
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Classification
Morel-Lavelle, 1845
S Location:
S Cervical
S Thoracic
S Diaphragmatic
S Etiology:
S Congenital
S Acquired
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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
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Differential Diagnosis
SNeoplasms
SAbscess
SSubcutaneous Emphysema
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Imaging
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Imaging
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Imaging
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Imaging
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Operative Techniques
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Operative Techniques
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Operative Techniques
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Operative Techniques
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Operative Techniques
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Types of Mesh
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Types of Mesh
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Biomaterials
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Biomaterials
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Biomaterials
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Biomaterials
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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
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Questions?
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References
Acute Innovations. (2012). BioBridge Resorbable Chest Wall Stabilization Plate [Brochure]. Hillsboro, OR: Author.
Coates, J. B., Berry, F. B., McFetridge, E. M., & Heaton, L. D. (1963). Thoracic surgery. Washington, D.C.: Office of the Surgeon General,
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
Kaiser, L. R., Kron, I. L., & Spray, T. L. (2007). Mastery of cardiothoracic surgery. Philadelphia: Lippincott, Williams & Wilkins.
Lord, F. T. (1915). Diseases of the bronchi, lungs, and pleura. Philadelphia: Lea & Febiger.
Macedo, A. C., Kay, F. U., Terra, R. M., Campos, J. R., Aranha, A. G., & Funari, M. B. (2013). Transdiaphragmatic intercostal hernia:
Imaging aspects in three cases. Jornal Brasileiro De Pneumologia, 39(4), 513-517. doi: 10.1590/S1806-37132013000400016
Marlow, S., Campbell, T., Davis, A., & Patel, H. R. (2013). Emergency ultrasound in the diagnosis of traumatic extrathoracic lung herniation.
The American Journal of Emergency Medicine, 31(3), 633.e1-633.e2. doi: 10.1016/j.ajem.2012.09.030
Miller, D. L., Force, S. D., Pickens, A., Fernandez, F. G., Luu, T., & Mansour, K. A. (2013). Chest Wall Reconstruction Using Biomaterials.
The Annals of Thoracic Surgery, 95(3), 1050-1056. doi: 10.1016/j.athoracsur.2012.11.024
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