Snapshot quiz 14/7

Published: 05/16/2014

Authors: Parkinson F and Stephenson BM

This is a costochondral hernia, which occurred after repeated episodes of violent coughing. CT  demonstrates a hand-sized defect in the costochondral margin and an unsuspected rib fracture (arrow). This hernia was successfully managed conservatively with a soft ‘filled’ truss-like support for 4 years. Although such defects and hernias may occur after trauma, where a diaphragmatic component can exist, ‘spontaneous’ hernias can present months after a seemingly innocuous respiratory infection. Their management, including the need for major reconstructive surgery, should be individualized, particularly in elderly patients with pulmonary disease.