A serious fit of cough: A 66-year-old patient with myasthenia gravis presenting with spontaneous intercostal lung herniation after coughing. Case report and pathophysiological discussion

  • Riccardo Gerloni Emergency Department, University Hospital of Cattinara, Italy.
  • Nicola Artusi | nicola.artusi.1@gmail.com Emergency Department, University Hospital of Cattinara, Italy. https://orcid.org/0000-0003-0998-4475
  • Ugo Giulio Sisto Emergency Department, University Hospital of Cattinara, Italy.
  • Saverio Tollot Radiology Department, University Hospital of Cattinara, Trieste, Italy.
  • Roberto Copetti Emergency Department, University Hospital of Cattinara; Emergency Department, Hospital of Latisana, Latisana, Italy.


We present a case of a 66-year-old man with history of myasthenia gravis, severe obesity and osteopenia self-presented to our Emergency Department (ED) with severe pain in his left hemithorax, occurred after an episode of cough three days before. No history of trauma was reported. The patient underwent a chest-XR showing uncomplicated spontaneous fractures of the 5th and 6th left ribs. He was therefore discharged with appropriate analgesic treatment. Five days later, the patient came back to our ED for a wide left abdominal hematoma, though hemodynamically stable and eupneic. A CT-scan with contrast showed a rare and unexpected spontaneous left intercostal lung herniation complicated with a diffuse subcutaneous emphysema, pneumothorax, loculated bilateral pleural effusion and abdominal hematoma. The patient was admitted, treated conservatively and safely discharged after two weeks. We also provide a pathophysiological discussion of the case and a literature review.



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Case Reports
Lung herniation, spontaneous, pulmonary hernia, obesity, myasthenia gravis
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How to Cite
Gerloni, R., Artusi, N., Sisto, U. G., Tollot, S., & Copetti, R. (2020). A serious fit of cough: A 66-year-old patient with myasthenia gravis presenting with spontaneous intercostal lung herniation after coughing. Case report and pathophysiological discussion. Emergency Care Journal, 16(3). https://doi.org/10.4081/ecj.2020.8911