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CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2018; 28(01): 134-135
DOI: 10.4103/ijri.IJRI_282_17
Letters to the Editor

Adult cervical lung herniation: Importance of valsalva manoeuvre in imaging

Rupinder Singh
Department of Radiodiagnosis, Sri Balaji Medical Institute, New Delhi, India
,
Ramanjeet Kaur
Department of Gynaecology, Kasturba Hospital, New Delhi, India
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Subject Editor: Financial support and sponsorship Nil.
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Sir,

A 52-year-old malepresented at our outpatient department for evaluation for thyroid nodule in the right lobe. He incidentally noticed swelling on the lower neck on coughing or forceful expiration for last 2months. He was a nonsmoker andhad no history of long standing cough or any hernia at other sites. On examination, a swelling was confirmed in the right lower neck when the Valsalva manoeuvre was performed [Figure 1] clinical photograph at rest and with Valsalva,]. In addition, pulsatility was seen on the left neck supraclavicular region due to displaced subclavian artery pulsations. Computed tomographic (CT) evaluation with Valsalva manoeuvre was performed keeping a differential diagnosis of laryngocele. Cervical lung herniation was excellently depicted with Valsalva CT acquisition [Figure 2]; coronal panels D and sagittal, panel E images] in comparison to images without Valsalva [Figure 2]; coronal images, panels A andC]. In addition, CT depicted bilateral cervical ribs (arrows) and arthrosis of the left cervical rib with exostosis from the superior surface of the first rib. Laboratory investigations revealed euthyroid state, and other investigations including routine chest X-ray were within normal limits. Fine needle aspiration cytology (FNAC) ofthyroid nodule done under ultrasound guidance confirmed itsbenign nature. Patient is on conservative treatment.

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Figure 1 (A and B): (A) Photograph of the patient at rest. (B) Photograph of the patient with Valsalva
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Figure 2 (A-F): Cervical lung herniation was excellently depicted with Valsalva CT acquisition on Ray sum projection neck and upper chest without and with valsalva (A and B) CT coronal reformat without and with valsalva (C and D), sagittal reformat with valsalva (E). Volume rendered image (F) depicting bilateral cervical ribs(arrows) and arthrosis of left cervical rib with exostosis from superior surface of first rib (arrow head)


Publication History

Article published online:
26 July 2021

© 2018. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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