Göğüs duvarı akciğer hernisi

Özet

Künt travma, kaburga-kostokondral hasar veya torakotomi sonrası akciğer parankimi göğüs duvarındaki zayıf alandan dışarı çıkabilir; öksürükle belirginleşen kitle de başvuru bulgusu olabilir. BT, akciğerin toraks içindeki parankimle devamlılığını, interkostal defekti, herni boynunu ve komşu kemik hasarını gösterir. Küçük herniler inspiratuvar BT’de belirgin olmayabilir; ekspirasyon veya Valsalva sırasında protrüzyon artabilir. BT’de herni açıklığı, komşu kırıklar ve olası parankimal etkilenme değerlendirilmelidir.

Faz ve pencere

Kontrastsız tanısal

Akciğer penceresinde aerasyonlu parankimin interkostal kas defektinden cilt altına doğru toraks içindeki akciğerle devamlılığı; yumuşak doku penceresinde herni kesesi, boynu ve komşu kas-kaburga yapıları değerlendirilir. Kontrast fazı herniyi göstermek için gerekli değildir; dar boyunda vasküler sıkışma/perfüzyon kuşkusu varsa kontrastlı değerlendirme ayrıca düşünülebilir.

Kemik algoritması tanısal

BT, herni boynunu, komşu kırıkları veya cerrahiye bağlı göğüs duvarı bozulmasını gösterebilir; çok düzlemli rekonstrüksiyonlar anatomik değerlendirmede önemlidir.

Önerilen pencereler: Akciğer (G 1500 / M -600), Yumuşak doku (G 400 / M 40), Kemik (G 1800 / M 400).

BT bulguları

• İnterkostal kas defekti — göğüs duvarında kas liflerinin kesintisi veya kaburgalar arasında genişlemiş açıklık.
• Plevra ile örtülü akciğer protrüzyonu — aerasyonlu akciğer dokusu göğüs kafesi sınırının dışına taşar ve intratorasik akciğerle devam eder.
• Herni boynu — parankimin toraks dışına geçtiği interkostal açıklık; sagittal ve koronal planda boyun anatomisi netleşebilir.
• Herni kesesi — cilt altı veya yumuşak doku konturunun altında kalan dışa çıkmış plevra-akciğer bileşimi.
• Kaburga/kostokondral hasar — defekt komşuluğunda kırık, ayrışma veya cerrahi kemik değişikliği görülebilir.
• Parankim kompresyonu — herni boynunda bronşiyal veya vasküler bası ve parankimal etkilenme bulunup bulunmadığı BT’de değerlendirilir.
• Travmatik akciğer hernisi başka göğüs yaralanmalarıyla birlikte bulunabilir; bir olgu bildiriminde herniye eşlik eden büyük yumuşak doku hematomu, kaburga kırığı ve hemotoraks tanımlanmıştır.

Normalde

Normal göğüs duvarında interkostal kaslar kaburgalar arasında süreklidir ve plevra-akciğer toraks sınırının içinde kalır. Karşı tarafın aynı kaburga seviyesindeki kas kalınlığı ve göğüs duvarı konturunu kıyaslayın; herni boynunda kas kesintisi ve dışarı taşan, akciğerle devamlı aerasyonlu doku arayın.

Ayırıcı tanı

Pnömotoraks, travmatik akciğer hernisiyle birlikte bulunabilir.

Subkutan amfizem, akciğer hernisinde bildirilen hava kaçağı ilişkili komplikasyonlar arasındadır; tanıda BT’de herniye akciğerin intratorasik parankimle devamlılığı gösterilir.

Bir olgu bildiriminde interkostal akciğer hernisine büyük bir yumuşak doku hematomu eşlik etmiştir.

Akciğer kontüzyonu, akciğer hernisinden farklı bir parankimal yaralanma türüdür.

Diyafram hernisi

abdominal içerik diyaframdaki defektten toraksa geçer; akciğer hernisinde ise akciğer dokusu göğüs duvarı defektinden dışarı protrüze olur.

Tuzaklar

• İnspirasyonda küçük veya aralıklı herni belirgin olmayabilir; belirgin klinik şişlik varsa standart kesitlerde herni boynunu çok düzlemli izleyin.
• Herni kesesi ile diğer bulguların ayrımında, plevra ile örtülü akciğer parankiminin intratorasik parankime devamlılığı ve bronkovasküler yapıların kesede devam ettiği doğrulanmalıdır.
• Yalnız dış konturu tariflemek açıklığı göstermez; defekti, herni boynunu, plevral örtüyü ve komşu kırığı birlikte lokalize edin.

Kendini dene

1. BT’de göğüs duvarı defektinden geçerek intratorasik akciğer parankimiyle devamlılık gösteren aerasyonlu doku hangi tanıyı destekler?

   • Akciğer hernisi
   • Diyafram hernisi
   • Superior lomber herni
   • Hiatal herni
   Cevabı göster

   Akciğer hernisi. Akciğer hernisinde aerasyonlu akciğer, göğüs duvarı defektinden geçerek intratorasik akciğer parankimiyle devamlılık gösterir.

2. BT'de göğüs duvarı defektinden dışarı protrüze olan yapının akciğer hernisi olduğunu doğrulayan en önemli bulgu hangisidir?

   • Plevra ile örtülü akciğer parankiminin intratorasik parankimle devamlılığı
   • Yumuşak doku planlarında çizgisel hava yoğunluğu
   • Kemik korteksinde sklerotik bölge
   • Mediastende yer değiştirmiş kalp kapakçıkları
   Cevabı göster

   Plevra ile örtülü akciğer parankiminin intratorasik parankimle devamlılığı. Kaynaklar, akciğer hernisinin tanı kriterinin, plevra ile örtülü akciğer parankiminin göğüs duvarı veya toraks girişindeki defekt üzerinden intratorasik parankimle anatomik devamlılık göstermesi olduğunu belirtir.

İlgili konular

• Akut kaburga kırığı
• Göğüs duvarı hematomu ve aktif kanama

Kaynaklar

Bu sayfadaki 33 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Compression fracture of the T12 vertebra combined with diaphragmatic hernia after low-energy trauma: a case report and literature reviewpmc.ncbi.nlm.nih.gov
2. Lung hernia: an updated narrative reviewpmc.ncbi.nlm.nih.gov
3. Beyond the Diaphragm: Grynfeltt-Lesshaft Hernia Presenting With Small Bowel Obstructionpmc.ncbi.nlm.nih.gov
4. Massive Bochdalek Hernia in an Adult Presenting With Cardiac Arrhythmias: A Case Reportpmc.ncbi.nlm.nih.gov
5. Single-stage hybrid repair of extensive aortic dissection with traumatic diaphragmatic herniapmc.ncbi.nlm.nih.gov
6. CT Findings of Pediatric Handlebar Injuries.pubmed.ncbi.nlm.nih.gov
7. Imaging of thoracic hernias: types and complications.pubmed.ncbi.nlm.nih.gov
8. Diaphragmatic Hernia of the Stomach with Gastric Rupture in a Domestic Pig.pubmed.ncbi.nlm.nih.gov
9. Complicated spontaneous intercostal lung hernia - A rare clinical case.pubmed.ncbi.nlm.nih.gov
10. Posttraumatic intercostal pulmonary herniation - case report.pubmed.ncbi.nlm.nih.gov
11. Intercostal lung herniation--the role of imaging.pubmed.ncbi.nlm.nih.gov
12. Minimally invasive management of traumatic lung herniation.pubmed.ncbi.nlm.nih.gov
13. Two cases of lung herniation treated by surgery or observation.pubmed.ncbi.nlm.nih.gov
14. [Spontaneous pulmonary hernia: report of a case].pubmed.ncbi.nlm.nih.gov
15. Lateral lung hernia following a low-energy trauma without bony injuries: A case report.pubmed.ncbi.nlm.nih.gov
16. [Spontaneous thoracic hernias--report of two cases, surgically treated].pubmed.ncbi.nlm.nih.gov
17. Traumatic lung herniation due to Cow's kick.pubmed.ncbi.nlm.nih.gov
18. 3D printed modeling contributes to reconstruction of complex chest wall instability.pubmed.ncbi.nlm.nih.gov
19. Soft Tissue Neoplasms Causing Apparent Venous Thoracic Outlet Syndrome.pubmed.ncbi.nlm.nih.gov
20. Lung hernia: an updated narrative review.pubmed.ncbi.nlm.nih.gov
21. Surgical management of complex non-union in chest wall instability: focus on posterior rib fractures, parasternal cartilage rupture, and costal margin injury.pubmed.ncbi.nlm.nih.gov
22. Comparative clinical study of total thoracoscopic surgery and thoracoscopy-assisted small-incision surgery for multiple rib fractures.pubmed.ncbi.nlm.nih.gov
23. Progressive Extension of a Post-intubation Tracheal Laceration Presenting As Massive Pneumomediastinum: A Case Report.pubmed.ncbi.nlm.nih.gov
24. Acute intercostal pulmonary hernia on postoperative day 5 following uniportal video-assisted thoracoscopic surgery: Successful emergency manual reinsertion case report and literature review.pubmed.ncbi.nlm.nih.gov
25. Spontaneous lung herniation: A rare ultrasound diagnosis.pubmed.ncbi.nlm.nih.gov
26. Diagnosis, Treatment, and Follow-Up of Tracheo/Bronchomalacia in Children: The Italian Multicenter Experience.pubmed.ncbi.nlm.nih.gov
27. The Wandering Pancreas: A Rare Case of Complex Hiatal Hernia Presenting With Thoracic Symptoms.pubmed.ncbi.nlm.nih.gov
28. Bilateral lung herniation with parenchymal infarction following clamshell thoracotomy for lobar lung transplantation: a case report.pubmed.ncbi.nlm.nih.gov
29. Chest Wall and Diaphragmatic Injuries: Imaging Evaluation and Clinical Considerations.pubmed.ncbi.nlm.nih.gov
30. Role of omental flaps in thoracic surgery complications: a narrative review.pubmed.ncbi.nlm.nih.gov
31. Surgical stabilization of rib fractures (SSRF): the WSES and CWIS position paper.pubmed.ncbi.nlm.nih.gov
32. Beyond the Diaphragm: Grynfeltt-Lesshaft Hernia Presenting With Small Bowel Obstruction.pubmed.ncbi.nlm.nih.gov
33. Painful large traumatic intercostal pulmonary hernia.pubmed.ncbi.nlm.nih.gov
34. Postoperative Pulmonary Complications: Clinical and Imaging Insightspubmed.ncbi.nlm.nih.gov
35. Incidental discovery of intercostal pulmonary hernia: A case report.pubmed.ncbi.nlm.nih.gov
36. Diaphragmatic endometriosis with hepatic herniation: case report and review of literature.pubmed.ncbi.nlm.nih.gov
37. Postoperative Residual Pleural Space: A Risk Factor for Chest Wall Hernia After Thoracoscopic Surgery.pubmed.ncbi.nlm.nih.gov
38. Case Report: A giant uterine leiomyoma with pseudo-Meigs syndrome combined with a triad of umbilical hernia-prolapse-thrombosis.pubmed.ncbi.nlm.nih.gov
39. Upright multidetector CT with 320-row gantry: a technical innovation providing insights into human anatomy under gravity and potential clinical implications.pubmed.ncbi.nlm.nih.gov
40. Effects of spinal deformities on lung development in children: a review.pubmed.ncbi.nlm.nih.gov
41. Lung Diseases and Rare Disorders: Is It a Lysosomal Storage Disease? Differential Diagnosis, Pathogenetic Mechanisms and Management.pubmed.ncbi.nlm.nih.gov
42. Emergency management of severe polytrauma with traumatic diaphragmatic hernia via EMSS: case report and literature review.pubmed.ncbi.nlm.nih.gov
43. Lung parenchymal trauma biomechanics, mechanisms, and classification: a narrative review of the current knowledge.pubmed.ncbi.nlm.nih.gov
44. Through the Gap: A Rare Case of Intercostal Lung Hernia.pubmed.ncbi.nlm.nih.gov
45. Optimising Autologous Breast Reconstruction: Pneumothorax and Pneumomediastinum-A Literature Review and First Reported Case of Pneumomediastinum Following Bilateral DIEP Flap Reconstruction.pubmed.ncbi.nlm.nih.gov
46. Magnetic resonance imaging evaluation of oblique injuries: Introduction of the deadrise sign.pubmed.ncbi.nlm.nih.gov
47. Differentiating Imaging Characteristics of Congenital Diaphragmatic Hernia and Diaphragmatic Eventration.pubmed.ncbi.nlm.nih.gov
48. Rectus abdominis muscle atrophy, prophylactic mesh, and stoma placement: retrospective findings from a prospective multicenter trial.pubmed.ncbi.nlm.nih.gov
49. Current treatment strategies and prospects for chest wall defect repair and reconstruction.pubmed.ncbi.nlm.nih.gov
50. Undiagnosed Thoracic Aortic Aneurysms: Prevalence, Risk Factors, Screening Modalities.pubmed.ncbi.nlm.nih.gov
51. A new oblique-to-side esophagogastric anastomosis approach reduces the incidence of postoperative anastomotic leak after esophagectomy for esophageal carcinoma: a propensity score-matched retrospective study.pubmed.ncbi.nlm.nih.gov
52. Minimally Invasive Sampling of Mediastinal Lesions.pubmed.ncbi.nlm.nih.gov
53. Boerhaave Syndrome-Narrative Review.pubmed.ncbi.nlm.nih.gov
54. Closed Tube Thoracostomy Morbidity Rate in a Philippine Tertiary Government Hospital: 6-Year Review.pubmed.ncbi.nlm.nih.gov
55. Bowel Obstruction After Gastric Bypass Surgery: A Narrative Review.pubmed.ncbi.nlm.nih.gov
56. New trends in the surgical management of soft tissue sarcoma: The role of preoperative biopsy.pubmed.ncbi.nlm.nih.gov
57. Thoracic trauma WSES-AAST guidelines.pubmed.ncbi.nlm.nih.gov
58. Society for Cardiovascular Magnetic Resonance 2024 Cases of SCMR case series.pubmed.ncbi.nlm.nih.gov
59. Laparoscopic Repair of an Incarcerated Parahiatal Hernia with Gastric Necrosis: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
60. Prenatal ultrasound diagnosis of a rare morgagni hernia: a case report.pubmed.ncbi.nlm.nih.gov
61. Growing Up With Developmental Lung Diseases: A Review for the Adult Pulmonologist.pubmed.ncbi.nlm.nih.gov
62. Hypogenetic lung syndrome in an adolescent: imaging findings with short review.pubmed.ncbi.nlm.nih.gov
63. Complex anterior chest wall reconstruction after extensive oncologic resections: a narrative review.pubmed.ncbi.nlm.nih.gov
64. Retrospective Review Is the Best View: A Primer for Residents and Radiologists on Missed Findings in Chest Radiography.pubmed.ncbi.nlm.nih.gov
65. International Society of Paediatric Surgical Oncology (IPSO) Surgical Practice Guidelines.pubmed.ncbi.nlm.nih.gov
66. Extra-cardiac findings in cardiovascular magnetic resonance: what the imaging cardiologist needs to know.pubmed.ncbi.nlm.nih.gov
67. Atraumatic Transdiaphragmatic Intercostal Hernia Following a Coughing Spell: A Case Report.pubmed.ncbi.nlm.nih.gov
68. Minimally invasive treatment for critical multiple trauma with traumatic diaphragmatic hernia combined with pelvic and acetabular fractures: a rare case report.pubmed.ncbi.nlm.nih.gov
69. Lung imaging methods: indications, strengths and limitations.pubmed.ncbi.nlm.nih.gov
70. Traumatic Abdominal Wall Hernia With Sigmoid Colon Transection Following Bicycle Handlebar Injury: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
71. Compression fracture of the T12 vertebra combined with diaphragmatic hernia after low-energy trauma: a case report and literature review.pubmed.ncbi.nlm.nih.gov
72. Thoracic and Abdominal Radiologic Anatomy of the Greater Cane Rat (<i>Thryonomys swinderianus</i>).pubmed.ncbi.nlm.nih.gov
73. Rib-indexed quantitative lung ultrasound versus chest X-ray for lung recruitment assessment in neonates with moderate-severe ARDS on surfactant therapy combined with prone position: a prospective observational study.pubmed.ncbi.nlm.nih.gov
74. Evaluating the role of BMI in survival and complications in older esophageal squamous cell carcinoma following esophagectomy.pubmed.ncbi.nlm.nih.gov
75. Congenital Peritoneopericardial Diaphragmatic Hernia in a Dog: Ventral Advancement Diaphragmatic Technique for Repair.pubmed.ncbi.nlm.nih.gov
76. Intrathoracic Kidney Associated with Congenital Diaphragmatic Hernia: Prenatal Detection and Outcomes.pubmed.ncbi.nlm.nih.gov
77. Point-of-Care Ultrasound and Clinical Findings in 14 Cats With High-Rise Syndrome.pubmed.ncbi.nlm.nih.gov
78. Readmissions and Emergency Room Visits Following Outpatient and Inpatient Herniorrhaphies.pubmed.ncbi.nlm.nih.gov
79. Ruptured giant splenic artery aneurysm with an exceptional concurrent gastric and transverse colonic fistula: A rare case report.pubmed.ncbi.nlm.nih.gov
80. Traumatic diaphragmatic ruptures: A multidisciplinary study in a tertiary health center.pubmed.ncbi.nlm.nih.gov
81. Extensive Odontogenic Deep Neck Infection Complicated by Necrotizing Fasciitis and Bilateral Mastitis: A Rare Case Report.pubmed.ncbi.nlm.nih.gov
82. Secondary Pneumomediastinum Following Bronchoscopic Interventions in Patients With Prolonged Tracheostomy Intubation: A Case Series.pubmed.ncbi.nlm.nih.gov
83. Expert consensus on imaging diagnosis of human infection with avian influenza.pubmed.ncbi.nlm.nih.gov
84. SPOT THE BOT: A comparative quality assessment of AI-generated written instructions for lung ultrasound training.pubmed.ncbi.nlm.nih.gov
85. Understanding Air in the Body: A Radiologic Perspective on Emphysematous and Traumatic Conditions.pubmed.ncbi.nlm.nih.gov
86. Revisiting Diabetic Myonecrosis: A Case Report Highlighting Diagnostic and Management Challenges.pubmed.ncbi.nlm.nih.gov
87. Asymptomatic diaphragmatic hernia in an elderly patient: case report and review of conservative management.pubmed.ncbi.nlm.nih.gov
88. 25 years of surgery in patients with congenital lung malformations: the Rotterdam experience.pubmed.ncbi.nlm.nih.gov
89. Imatinib-Associated Interstitial Lung Disease with a Fibrotic NSIP Pattern on Transbronchial Lung Cryobiopsy: A Case Report and Review of the Literature.pubmed.ncbi.nlm.nih.gov
90. Thoracolaparoscopic management of a traumatic subacute transdiaphragmatic intercostal hernia. Second case reported.pubmed.ncbi.nlm.nih.gov
91. Surgical Stabilization of Rib Fractures: Indications, Techniques, and Pitfalls.pubmed.ncbi.nlm.nih.gov
92. The modified Ravitch approach for the management of severe anterior flail chest with bilateral sternochondral dislocations: a case report.pubmed.ncbi.nlm.nih.gov
93. Chest pain in patients with COPD: the fascia's subtle silence.pubmed.ncbi.nlm.nih.gov
94. Minimally invasive surgery in neonates and infants.pubmed.ncbi.nlm.nih.gov
95. Thoracoscopic Primary Repair for Spontaneous Esophageal Rupture in a Patient With Acute Irreducible Inguinal Hernia: A Case Report.pubmed.ncbi.nlm.nih.gov
96. Unilateral orbital surgical emphysema following laparoscopic hiatal hernia repair and Nissen fundoplication: a case report.pubmed.ncbi.nlm.nih.gov
97. Atypical presentation of congenital diaphragmatic hernia with gastric ischemia and coffee-ground emesis in late infancy: a case report and literature review.pubmed.ncbi.nlm.nih.gov
98. The Diagnostic Value of D-Dimer Testing in the Differential Diagnosis of Acute Abdomen in the Emergency Department.pubmed.ncbi.nlm.nih.gov
99. Strangulated Adult Bochdalek Hernia With Extensive Small Bowel Necrosis and Septic Shock.pubmed.ncbi.nlm.nih.gov
100. Traumatic diaphragmatic hernia: A 38-case retrospective analysis of presentation and outcomes.pubmed.ncbi.nlm.nih.gov
101. Delayed Traumatic Diaphragmatic Hernia Presenting With Gastric Volvulus and Necrosis: A Case Report and Literature Review.pubmed.ncbi.nlm.nih.gov
102. Tomographic aspects of penetrating thoracic trauma: injuries from firearms and other weapons.pubmed.ncbi.nlm.nih.gov
103. Multidetector computer tomography: evaluation of blunt chest trauma in adults.pubmed.ncbi.nlm.nih.gov
104. Thoracic and Umbilical Endometriosis Concurrently Presenting During Secondary Subfertility Evaluation.pubmed.ncbi.nlm.nih.gov
105. Pneumothorax and Hemothorax: Practical Approaches for Radiologists.pubmed.ncbi.nlm.nih.gov
106. Checklist for responsible deep learning modeling of medical images based on COVID-19 detection studies.pubmed.ncbi.nlm.nih.gov
107. International Consensus Statement on Obstructive Sleep Apnea.pubmed.ncbi.nlm.nih.gov
108. Acute and chronic complications of cesarean delivery: An update for the general radiologist.pubmed.ncbi.nlm.nih.gov
109. Emphysematous conditions of the abdomen and pelvis: pearls and pitfalls.pubmed.ncbi.nlm.nih.gov
110. Electronic Cigarette or Vaping-Associated Lung Injury Case Report.pubmed.ncbi.nlm.nih.gov
111. Chest CT examinations in patients presenting with acute chest pain: a pictorial review.pubmed.ncbi.nlm.nih.gov
112. Cystic and cavitary lung lesions in children: radiologic findings with pathologic correlation.pubmed.ncbi.nlm.nih.gov
113. Staged management of severe polytrauma with pericardial and diaphragmatic rupture and open pelvic ring injury: a case report with literature review.pubmed.ncbi.nlm.nih.gov
114. Tension Gastrothorax in a Child With Undiagnosed Congenital Diaphragmatic Hernia: A Case Report and Proposed Emergency Management Algorithm.pubmed.ncbi.nlm.nih.gov
115. Spontaneous pneumothorax and pneumomediastinum in patients with COVID-19: A case series from Iran.pubmed.ncbi.nlm.nih.gov

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