IP International Journal of Medical Paediatrics and Oncology 2021;7(2):108–111 Content available at: https://www.ipinnovative.com/open-access-journals IP International Journal of Medical Paediatrics and Oncology Journal homepage: https://www.ijmpo.com/ Case Report Congenital pulmonary hernia secondary to absence of ribs Arka Banerjee 1 , Shasanka S Panda 1 , Sujoy Neogi 1, *, Simmi K Ratan 1 1 Dept. of Pediatric Surgery, Maulana Azad Medical College, New Delhi, India ARTICLE INFO Article history: Received 16-06-2021 Accepted 22-06-2021 Available online 03-08-2021 Keywords: Pulmonary hernia Absent rib ABSTRACT Congenital lung hernia is extremely rare with less than 50 reported cases. We report two cases of lung hernia, secondary to congenital absence of ribs – A 4-year-old girl without any antecedent history of chronic cough or chest trauma presenting with a left lower lobe hernia secondary to an absent left 9th rib; a 7 month-old girl with recurrent pneumonia presenting with severe respiratory distress, fever and severe malnourishment, found to have absent 6th-9th ribs on right side with associated liver and lung herniation. The older girl has been kept on observation without surgery but the infant expired within 48 hours of admission due to respiratory failure. The clinical scenario is a rarity and can be managed conservatively in most cases. Surgical treatment should be considered in symptomatic patients and in those with severe complications. Repair for cosmetic reasons is sometimes justified. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1. Introduction Hernia is a general term used to describe an abnormal protrusion of an organ through the structure or muscle that usually contains it. Pulmonary or lung hernia (also known as a pneumocele) is an extremely rare entity. It refers to part of a lung bulging through a weak spot in the chest wall. In most of the reported patients, lung hernias are the result of injury or trauma to the chest, such as a fall, road traffic injury or surgery. Congenital lung hernia is extremely rare with less than 50 cases reported till date. We report two such cases of lung hernia, secondary to congenital absence of ribs, along with a review of the literature. * Corresponding author. E-mail address: drsujoyneogi@yahoo.com (S. Neogi). 2. Case Reports 2.1. Case 1 A 4-year-old girl with no history of chronic cough or any chest trauma came with a swelling on the left lower chest. She had no associated symptoms like pain, cough, respiratory distress, etc. 2.1.1. Past history was unremarkable. On examination, it was a 4x4 cm globular lump in the left lower antero-lateral chest wall approximately 8-9 cm lower and lateral to the left nipple. (Figure 1) The swelling was soft, cystic with a smooth surface, reducible and moved in and out with respiration. The patient underwent a chest CT scan and a lung hernia was revealed along with an absent left 9 th rib. Associated findings included a flattened 8 th rib and bifid 10 th rib on the left side. The ribs on the right side were all normal. No abnormalities were noted in the lung fields. (Figure 2) The patient has been under observation and 6-monthly OPD follow-up for the last 16 months and is doing fine till date. https://doi.org/10.18231/j.ijmpo.2021.021 2581-4699/© 2021 Innovative Publication, All rights reserved. 108