Lung hernia: an updated narrative review

Pulmonary (lung) hernia is an uncommon condition in which aerated lung protrudes beyond the normal confines of the thorax through a defect at the thoracic inlet, chest wall, mediastinum, or diaphragm. Although historically linked to trauma, recent reports increasingly involve postoperative patients, including those after lung transplantation, and situations associated with repeated spikes in intrathoracic pressure. We conducted a narrative review to summarize contemporary diagnosis and management.

We performed a targeted literature search of MEDLINE (via PubMed), ScienceDirect, the Cochrane Library, Taylor and Francis Online, and ClinicalTrials.gov from inception through December 31, 2025. The search was performed in January 2026. We included studies in English or French describing pulmonary or lung hernia of any anatomic subtype or etiology in humans. We extracted data on hernia location, suspected cause, clinical presentation, imaging, management strategy, complications, and outcomes.

The literature is dominated by case reports and small series with heterogeneous definitions and inconsistent reporting of defect anatomy, operative technique, and follow-up. Most published cases involve thoracic or intercostal defects, while cervical hernias are less common and mediastinal or diaphragmatic variants are rare. Computed tomography is the primary diagnostic test, sometimes supported by dynamic maneuvers to reproduce the protrusion. Management is guided by symptoms and anatomy. Observation is often chosen for small, reducible defects, whereas progressive enlargement, pain, impaired reducibility, concern for incarceration, ventilatory dependence, or chest wall instability typically lead to operative repair with reconstruction and selective reinforcement.

More consistent reporting and multicenter data are needed to define progression risk and compare surgical techniques and materials, particularly in high-risk postoperative and post-thoracic transplant populations.