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SAEM Clinical Image Series: Chest Wall Mass

Posted by Harry Stark MD, MBS on

A 71 year-old patient with a past medical history of hypertension, percutaneous transluminal coronary angioplasty 7 years ago, and robotic coronary artery bypass grafting of the left internal mammary artery to the left anterior descending artery 9 years ago presents with worsening dyspnea on exertion. He had a biopsy of the upper lobe of the left lung the week before. He was having a neoplastic mass evaluated. The patient presents with a soft left-sided anterior chest mass, inflating and deflating with respiration.

Physical Exam

Vital signs: Respiratory rate 25 breaths/min, oxygen saturation 96% on room air; remaining vital signs within normal limits

General: Resting comfortably

Chest: Soft mass expanding and retracting above the left nipple

Laboratory Data

Labs within normal limits

Case Question: What is the anterior chest wall mass and its etiology?

This is an iatrogenic anterior chest wall lung herniation as a sequela of robotic coronary artery bypass grafting. This was chronic and unrelated to the patient presentation. The patient presented with dyspnea that was actually caused by another iatrogenic complication — pneumothorax from lung biopsy.

Case Discussion

Lung herniation can be a rare complication in minimally invasive cardiothoracic surgery.

Copyright

Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2019 SAEM Annual Meeting | Copyrighted by SAEM 2019 – all rights reserved. View other other cases from this series on ALiEM.

Author information

Harry Stark MD, MBS

Emergency Medicine Resident
St. John's Riverside Hospital

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