Cough-induced chest wall trauma with spontaneous intercostal lung herniation complicated by haemothorax

We report a rare case of cough-induced chest wall trauma with spontaneous intercostal lung herniation complicated by haemothorax. A man in his early 70s with chronic obstructive pulmonary disease, asthma and prior thoracic trauma presented with chest pain. Initial investigations focused on a cardiac cause due to elevated troponin levels. During admission, he developed extensive ecchymosis over the flanks, abdomen and back, prompting CT imaging of the abdomen that included the lung bases. This revealed new intercostal lung herniation that was not present on CT pulmonary angiography performed 4 days earlier. Clinical deterioration necessitated surgical intervention, including haematoma evacuation, reduction of herniated lung and costal arch repair. Flexible bronchoscopy was performed for secretion clearance and microbiological sampling. This case highlights the importance of considering spontaneous lung herniation following forceful coughing in patients with recognised risk factors.