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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We report the case of a 39-year-old obese patient with a history of rheumatoid arthritis treated with chronic corticosteroids who consulted due to pain in the right hemithorax after a coughing fit&#46; Physical examination revealed a significant haematoma in the right hemithorax and flank&#46; X-ray showed right lateral fractures&#44; with no other associated complications&#46; The patient was treated with non-steroidal anti-inflammatory drugs and opioids for 3 months with no improvement of pain&#44; so chest computed tomography was requested that revealed unconsolidated fractures of the 7th&#44; 8th and 9th costal arches and intercostal diastasis of the 7th space associated with pulmonary herniation &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>A&#41;&#46; Thoracotomy was scheduled&#46; Two diaphragmatic defects of 5<span class="elsevierStyleHsp" style=""></span>cm and 3<span class="elsevierStyleHsp" style=""></span>cm with herniation of abdominal fat were observed intraoperatively &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>B&#41;&#46; The diaphragmatic defects were repaired with Prolene&#174; and polytetrafluoroethylene sutures&#44; stainless steel costal fixation&#44; and biological mesh &#40;Permacol&#174;&#41; on the costal plane &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>C&#41;&#46; The postoperative progress of the patient was satisfactory with remission of pain&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Although the increase in intrathoracic pressure combined with chest wall weakness can lead to costal fractures and pulmonary herniation&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> associated diaphragmatic rupture is exceptional&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; G&#243;mez Hern&#225;ndez MT&#44; Rodr&#237;guez Alvarado I&#44; Jim&#233;nez L&#243;pez MF&#46; Fracturas costales&#44; hernia pulmonar y rotura diafragm&#225;tica tras acceso de tos&#46; Arch Bronconeumol&#46; 2020&#59;56&#58;391&#46;</p>"
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