SAEM Clinical Image: Chest Wall Mass

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

The post SAEM Clinical Image Series: Chest Wall Mass appeared first on ALiEM.

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SAEM Clinical Image Series: Chest Wall Mass