Intercostal lung herniation after cardiopulmonary resuscitation masked by diffuse subcutaneous emphysema

The incidence of rib fractures among adults with cardiac arrest following chest compressions is approximately 30%. We present a case of lung herniation following manual and mechanical cardiopulmonary resuscitation (CPR). In our case, it was difficult to identify bulging of the lung in the intercostal space initially due to diffuse subcutaneous emphysema. After pigtail drainage, the subsequent image showed a lung air pocket in the left anterior chest wall, compatible with the findings on chest CT imaging. Our case reminds the clinical physician of the importance of chest CT to help timely diagnosis of lung herniation and a detailed study of the underlying anatomy for patients developing diffuse subcutaneous emphysema after CPR to prevent potentially fatal complications.