Cervical pulmonary hernia: a differential diagnosis of thyroid nodule to keep in mind

Malika El Omri; Jemli S; Bellakhdher Mouna; Meherzi Abir; Houas Jihene; Ghammem Monia; Ach Taieb; Kermani Wassim; Abdelkefi Mohamed

doi:10.1530/endoabs.99.EP957

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Endocrine Abstracts (2024) 99 EP957 | DOI: 10.1530/endoabs.99.EP957

ECE2024 Eposter Presentations Thyroid (198 abstracts)

Cervical pulmonary hernia: a differential diagnosis of thyroid nodule to keep in mind

El Omri Malika ¹ , Jemli S ¹ , Bellakhdher Mouna ¹ , Meherzi Abir ¹ , Houas Jihene ¹ , Ghammem Monia ¹ , Ach Taieb ² , Kermani Wassim ¹ & Abdelkefi Mohamed ¹

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¹ENT department Farhat Hached hospital, Sousse, Tunisia; ²Endocrinology department Farhat Hached hospital, Sousse, Tunisia

Introcduction: Pulmonary herniation is defined as a protrusion of the lung and its pleural layers beyond the normal limits of the rib cage. It can be cervical, intercostal or diaphragmatic. Cervical hernia develops from the apex of the lung and represents approximately one third of pulmonary hernias and 60% of congenital lesions e report a case of cervical pulmonary hernia, in order to discuss the epidemiological etiopathogenic and clinical particularities of this entity.

Observation: It was a 38 year old man smoker with chronic cough with the medical history bilateral inguinal hernia and umbilical hernia that were surgically treated He consulted our department for a right side-cervical swelling evolving for 2 years which increased in size when coughing. Physical examination revealed a right side-cervical swelling of 7 cm long axis which manifested itself during coughing. The remainder of the ENT examination was unremarkable. The cervical CT scan concluded that there was a cervical lung herniation due to the abnormal presence of lung tissue at the cervical level. The patient was referred to the vascular and thoracic surgery department for surgery.

Conclusion: Cervical pulmonary hernia is a rare clinical entity; its often difficult diagnosis is facilitated by chest CT scanning. It is almost always lateralized to the right with a possible deviation of the trachea towards the left. Their appearance results from the conjunction of a weakening of wall resistance and an increase in intrathoracic pressure. Chronic cough, emphysema, physical exertion promote the appearance of these hernias.