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. Physical examination revealed a significant haematoma in the right hemithorax and flank. X-ray showed right lateral fractures, with no other associated complications. The patient was treated with non-steroidal anti-inflammatory drugs and opioids for 3 months with no improvement of pain, so chest computed tomography was requested that revealed unconsolidated fractures of the 7th, 8th and 9th costal arches and intercostal diastasis of the 7th space associated with pulmonary herniation (Fig. 1A). Thoracotomy was scheduled. Two diaphragmatic defects of 5cm and 3cm with herniation of abdominal fat were observed intraoperatively (Fig. 1B). The diaphragmatic defects were repaired with Prolene® and polytetrafluoroethylene sutures, stainless steel costal fixation, and biological mesh (Permacol®) on the costal plane (Fig. 1C). The postoperative progress of the patient was satisfactory with remission of pain.
(A) Three-D reconstruction of computed tomography showing fractures of the 7th, 8th and 9th costal arches and intercostal diastasis of the 7th space, associated with pulmonary herniation. (B) Five cm diaphragmatic defect repaired with Prolene® and polytetrafluoroethylene sutures. (C) Biological mesh (Permacol®) on costal plane.
Although the increase in intrathoracic pressure combined with chest wall weakness can lead to costal fractures and pulmonary herniation,1 associated diaphragmatic rupture is exceptional.
Please cite this article as: Gómez Hernández MT, Rodríguez Alvarado I, Jiménez López MF. Fracturas costales, hernia pulmonar y rotura diafragmática tras acceso de tos. Arch Bronconeumol. 2020;56:391.
