SHM Converge Scientific Abstract ePoster Gallery-An Unusual Complication of Community Acquired Pneumonia: Lung Herniation With Empyema Secondary From Cough Induced Rib Fractures

An Unusual Complication of Community Acquired Pneumonia: Lung Herniation With Empyema Secondary From Cough Induced Rib Fractures

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This case describes a rare complication of community-acquired pneumonia in a 74-year-old woman with asthma and osteoporosis who developed progressive left flank and lateral chest wall pain after coughing, without trauma or prior surgery. Initial CT imaging suggested empyema with possible bronchocutaneous fistulization, but drainage was deferred because there was no clear drainable fluid collection and the patient had high procedural/surgical risk. She was treated conservatively with antibiotics and pain control.<br /><br />Her condition later worsened with acute hypoxic respiratory failure requiring ICU care. Repeat imaging showed a new sixth rib fracture, an enlarging loculated pleural effusion, and herniation of lung tissue into the left chest wall through an eighth rib defect, consistent with spontaneous lung herniation likely caused by cough-induced rib fractures. Thoracentesis and then chest tube placement were performed for source control.<br /><br />The report highlights that spontaneous lung herniation with empyema after coughing is uncommon and lacks standardized management guidelines. In stable patients, conservative treatment may be appropriate initially, but close monitoring is essential because deterioration can occur quickly. This case emphasizes the need to escalate to procedural intervention when respiratory failure, enlarging effusion, or inadequate infection control develops. After chest tube placement, follow-up CT showed persistent rib fracture and herniation but improved pleural effusion.

Asset Subtitle

Vanessa Lim

Meta Tag

Author List Adam Rothman, Angelica Rozenfeld, Dayita Wable, Leore Lavin, Thomas F. Fusillo, Vanessa Lim

Category Clinical Vignettes

Concept Lung Herniation

Concept Empyema

Concept Cough-Induced Rib Fracture

Concept Pleural Effusion

Concept Community-Acquired Pneumonia

Distinguished Non-Finalist

Presenter Organization Mount Sinai Morningside / West

Presenting Author Vanessa Lim

Track Adult

Keywords

community-acquired pneumonia

spontaneous lung herniation

cough-induced rib fracture

empyema

pleural effusion

acute hypoxic respiratory failure

thoracentesis

chest tube placement

conservative management

computed tomography

Lung Herniation

Empyema

Cough-Induced Rib Fracture

Pleural Effusion

Community-Acquired Pneumonia