[Extrathoracic prolapse of the pulmonary parenchyma after a bout of coughing with spontaneous serial rib fractures].

A 54-year-old man with an feverish infection of the lower respiratory tract developed severe pain in the lateral and basal part of the left thorax after a severe coughing bout. A haematoma occurred at the site and it looked as though tissue evaginated at that spot on coughing and pressing. The clinical diagnosis was pneumonia and abnormal mobility of the eighth to tenth rib on the left with crepitations. The chest radiograph demonstrated fractures of these ribs and extrathoracic sickle-shaped collection of air in the left laterobasal area. Computed tomography additionally showed prolapse of pulmonary tissue on pressing. This was thus a case of "cough fracture", complicated by herniation of lung tissue. There was no evidence of incarceration of lung tissue and, as the patient was very obese, surgery was not indicated. Symptoms and signs of infection regressed on symptomatic and antibiotic treatment. The rib fractures healed as pseudoarthroses. Lung tissue prolapse on pressing was still present 3 months later.