Images in Clinical Medicine
Lung Herniation after Cardiopulmonary Resuscitation
N Engl J Med 2004; 351:695August 12, 2004
- Article
A 63-year-old man collapsed, unresponsive and pulseless, at his workplace. Security guards, using an automated external defibrillator, delivered two shocks to his chest and performed cardiopulmonary resuscitation (CPR) until paramedics arrived and intubated the patient. After the return of spontaneous circulation, he was transported to the hospital. A high-resolution computed tomographic (CT) scan confirmed the diagnosis of pulmonary embolism. The patient, whose condition by this time was hemodynamically stable, was treated without thrombolytic agents; he received unfractionated heparin and oxygen and underwent mechanical ventilation overnight. Thirty minutes after self-extubation, the patient reported dyspnea, and subcutaneous emphysema developed, which was especially pronounced in the left lung. After reintubation, urgent CT scanning of the chest revealed herniation of the left lung (arrows), with surrounding subcutaneous emphysema, pneumopericardium, and pneumomediastinum but without pneumothorax. The lung herniation had occurred at the site of a rib fracture, which was attributed to the CPR provided before hospital admission. A wedge resection of the left lung and tube thoracostomy were performed. After a protracted hospital stay, the patient was discharged home, with full neurologic recovery.
Laura D. Sprague, D.O.
Filippo J. Ferrigni, M.D.
SSM St. Joseph Health Center, St. Charles, MO 63301
