Traumatic pulmonary hernia : Surgical versus conservative management

The therapeutic management of lung herniation, an uncommon complication of severe blunt chest trauma, remains controversial. We report here on two cases of traumatic lung herniation with different, yet successful, methods of therapeutic management according to the particular anatomic types. Because of the threat of tension pneumothorax, incarceration, or strangulation of the lung parenchyma in mechanically ventilated patients, surgical reduction of intercostal pulmonary hernias with narrow necks is usually recommended. In contrast, supraclavicular pulmonary hernias secondary to clavicle-sternal dislocation may be treated conservatively with serial clinical and thoracic imaging follow-up including chest computed tomographic scan. In this anatomical type of lung herniation, favorable spontaneous evolution is frequently observed, presumably because of the presence of a larger thoracic wall defect together with the absence of associated perforating bone trauma. The efficacy of the therapeutic approach proposed herein remains to be confirmed by further experience.