Extrathoracic Lung Herniation from Blunt Trauma: A Review.

Introduction The Organ Injury Scale for chest wall trauma, last updated in 1992, governs the diagnosis and management of nearly half of all trauma patients. When this scale is used in association with the abbreviated injury score (AIS) and the trauma injury severity score (TRISS), overall survival following trauma can be estimated. There is presently no standardized scoring system for blunt chest wall trauma in the setting of lung herniation. Methods A systematic review of the literature on blunt chest wall trauma was completed and all reports of lung hernias since 1500 compiled. Four hundred cases of blunt trauma to the chest leading to lung herniation were identified and used to develop a classification scheme for extrathoracic lung herniation, adapt the organ injury scale for chest wall trauma to include extrathoracic lung hernias, and elucidate a treatment algorithm based on the type of lung hernia. Results Lung hernias can be divided into anterior and posterior; anterior hernias can be further divided into intercostal and parasternal. Intercostal hernias should be managed acutely by way of anterior chest wall exposure and potential thoracotomy due to the significantly higher risk of incarceration and/or strangulation. Discussion Anterior lung hernias should be grade III (AIS 3), parasternal lung hernias as grade IV (AIS 4), posterior lung hernias or the presence of any incarcerated lung as grade V (AIS 4), and strangulated lung hernias as grade VI (AIS 5). Incarcerated or strangulated lung has a high reported morbidity and mortality. [ABSTRACT FROM AUTHOR]