B47-06 RSV-induced Spontaneous Lung Herniation Due to Paroxysmal Coughing

Introduction Lung herniation, the protrusion of lung tissue through a thoracic wall defect, is an uncommon condition typically linked to trauma, surgical procedures, or congenital abnormalities. Spontaneous lung herniation is even rarer and is primarily attributed to abrupt increases in intrathoracic pressure from events like severe coughing. While Respiratory Syncytial Virus (RSV) is increasingly recognized as a cause of significant illness in adults , its role in precipitating lung herniation is not well-documented. We present a unique case of spontaneous lung herniation following an RSV-induced coughing episode, complicated by a large chest wall hematoma and acute blood loss anemia. Case Presentation A 54-year-old male with obesity (BMI 43.9 kg/m²) , hypertension, and obstructive sleep apnea presented with sharp, left-sided rib pain and extensive ecchymosis. Symptoms began five days prior after a severe coughing fit, during which he felt a “pop” in his left rib area. On arrival, he was tachycardic to 123 bpm. Physical exam revealed a large ecchymosis over the left lateral chest. Labs were notable for leukocytosis (WBC 16.2 x109/L) and acute normocytic anemia (hemoglobin 11.1 g/dL, down from a 16.6 g/dL baseline). A chest CT confirmed a 3.5 x 8.9 cm left chest wall hematoma and herniation of the left lung through a defect between the eighth and ninth ribs, with no rib fractures. RSV was detected via PCR. The patient subsequently developed a Streptococcus pneumoniae superinfection. He was managed conservatively with pain control and serial hemoglobin monitoring, which nadired at 9.4 g/dL , and was discharged on hospital day 3. Discussion/Conclusion This case highlights an exceedingly rare occurrence of spontaneous lung herniation secondary to an RSV infection in an adult. The lack of a rib fracture suggests the injury resulted from an intercostal muscle rupture caused by high intrathoracic pressure from paroxysmal coughing. High clinical suspicion is warranted in patients presenting with chest pain and ecchymosis following severe coughing, even without trauma. Conservative management with close monitoring is an appropriate first-line approach in stable patients. This case underscores that severe RSV infection in adults can lead to significant, non-traumatic mechanical complications. This abstract is funded by: None