Abstract
Intersternum lung hernia is extremely rare, with no previously published report. A 76-year-old man was referred to our unit due to lung hernia after debridement for mediastinitis that developed as a complication of total arch replacement for thoracic aortic aneurysm, and suction of drainage tube was performed continuously. He had a fever and hemosputum, and chest computed tomography revealed an intersternum hernia of the right middle lobe of the lung, right pleural effusion, and subcutaneous emphysema. He underwent an emergent operation. We identified the locking of the lung intersternum through the right pleura which was injured by the sternal edge, sharpened by the second debridement, and injury of the lung pleura with air leakage. This site was resected, and the sternum space was filled with bilateral greater pectoral muscle flaps. The postoperative course was favorable. He was discharged a month after the operation. However, mediastinitis recurred two months after discharge, and he died of sepsis. We think he developed the intersternum lung hernia due to the following. First, when the previous operation was performed, the intersternal space was not filled. Second, countinuous suction of the drainage tube after second debridement was performed, which might have worsened the locking of the lung intersternum. Third, the pleura was injured by debridement for mediastinitis. As a result, the passage of the lung to the intersternum was created. Fourth, the edge of the sternum following debridement was sharp enough to injure the lung that herniated to the intersternum. Fifth, the retention of right pleural effusion was observed without drainage. It is very important to avoid this condition through careful examination and prompt treatment.
