Abstract Introduction Pulmonary hernia (PH) is a rare entity in which lung parenchyma and pleura protrude through a chest wall defect. While most acquired PHs arise after trauma or surgery, spontaneous intercostal hernias following cough or infection remain exceptionally uncommon. We report a posterior intercostal spontaneous PH associated with pneumonia and subsequent recurrent fat herniation, highlighting diagnostic and surgical considerations unique to this presentation. Case Description A 64-year-old man with hypertension and active tobacco use presented with pleuritic pain and a new oxygen requirement two weeks after a forceful coughing episode during an upper respiratory infection. CT chest revealed partial herniation of the left lower lobe through the eighth posterior-lateral intercostal space, with lobe consolidation. Broad-spectrum antibiotics (vancomycin and cefepime) were initiated for pneumonia. Persistent pain and soft-tissue motion prompted lateral thoracotomy with primary repair. Six months later, the patient developed recurrent discomfort and intercostal fat herniation without lung recurrence, treated successfully with repeat thoracotomy and Ventralight mesh reinforcement following weight reduction. Postoperatively, symptoms resolved with no recurrence on follow-up. Discussion This case represents a rare spontaneous posterior intercostal pulmonary hernia precipitated by cough and pneumonia, complicated by delayed recurrent soft-tissue herniation—a sequence seldom described in literature. Acquired PHs comprise ∼80% of all cases, but spontaneous variants are underrecognized. Elevations in intrathoracic pressure from cough, obesity, and chronic lung injury likely contributed. Multiplanar CT imaging is essential for diagnosis and surgical planning. While asymptomatic PHs may be observed, symptomatic or enlarging lesions warrant repair, ideally with mesh reinforcement in high-risk patients to prevent recurrence.This case underscores the importance of considering PH in patients with pleuritic pain post-cough or infection and the value of reinforced repair strategies in preventing reherniation. This abstract is funded by: None
Toedt et al. (Fri,) studied this question.