A rare case of lung hernia associated with rib fractures and tension pneumothorax post cardiopulmonary resuscitation.

Rib fractures are the most common injury after cardiopulmonary resuscitation (CPR) for non-traumatic cardiac arrest. Pneumothorax can evolve into tension pneumothorax with assisted ventilation leading to hypotension and cardiac arrest. Lung hernia post-CPR is rare but a potentially fatal complication. Here we describe a 67-year-old female who presented to the emergency department (ED) with acute infective asthma exacerbation. She received initial treatment of inhaled salbutamol and ipratropium bromide, oral prednisolone, supplemental oxygen, and intravenous ceftriaxone. Shortly after administration of ceftriaxone, she went into unexpected cardiac arrest. She had return of spontaneous circulation with cardiopulmonary resuscitation but remained unconscious. She was intubated but subsequent resuscitation was complicated by tension pneumothorax, bronchospasm resulting in dynamic hyperinflation, rib fractures, and lung hernia. The lung hernia was initially mistaken as subcutaneous emphysema on chest radiography. Despite epinephrine infusion, mechanical ventilation, and decompression tube thoracostomy, the patient suffered a second cardiac arrest and further resuscitation was ceased. The case demonstrates that lung hernia may be misinterpreted as subcutaneous emphysema secondary to tube thoracostomy on chest radiography. Early recognition for consideration of surgical intervention is essential especially in patients with incarcerated lung hernia and respiratory failure.