First, etiology
The etiology and pathogenesis of lung hernia at different locations and different pathological types are not the same. Based on the comprehensive literature reports, the etiology and pathogenesis are closely related to congenital developmental abnormalities or acquired injuries leading to local defects or weakness.
1、Local developmental abnormality or weakness
(1) there is a fissure between the sternocleidomastoid muscle and the anterior oblique muscle of the neck, and the tension at the apex of the lung is high, with a large difference in expansion and contraction, which can cause local muscle relaxation, especially when the Sibsons fascia is defective, weak, or torn, lung tissue can herniate into the neck through this weak fissure, causing cervical lung hernia.
(2) there is a physiological weak point in the anterior upper and posterior lower parts of the mediastinal pleura. When the weakness is obvious or there are other developmental defects (such as the absence of one lung on one side), lung tissue is prone to herniate through this place into the mediastinum to form mediastinal lung hernia. Also, because the mediastinum and the neck are connected, the lesion can extend to the neck continuously during development, forming a mediastinal-Cervical lung hernia.
2、Trauma:Trauma can cause chest wall defects and weakness. When the intrathoracic or pulmonary pressure is abnormally increased, lung tissue can herniate into the intercostal space, causing chest (intercostal) lung hernia.
(1) rib fracture, pleural parietal layer, and chest wall muscle tear can cause chest wall defects, weakness, or pneumothorax, which in turn can cause lung hernia.
(2) trauma, etc. lead to local nerve injury, and over time cause local muscle atrophy, decreased tension, and the formation of lung hernia.
(3) improper treatment of pleural parietal layer and intercostal tissue injury, such as chest wall penetrating injury with a long wound, only the skin of the chest wall is sutured, but the chest wall muscle and pleural parietal layer are not sutured, which can lead to the occurrence of lung hernia. There are even reports of lung hernia occurring due to repeated thoracentesis.
3、Increased intrathoracic or pulmonary pressure:For example, pneumothorax can promote the herniation of lung tissue from the defective and weak parts.
4、Hereditary:Chen Runde et al. (1994) reported a family of three generations4All patients with cervical lung hernia have no history of trauma, chronic respiratory system diseases, or any triggering factors. They propose that the disease may be an autosomal dominant genetic disease based on the continuous transmission phenomenon of lung hernia in the family. However, no abnormalities were found in the family chromosome examination, and no similar reports have been seen besides. Therefore, whether lung hernia is a dominant genetic disease still needs to be further confirmed.
Second, pathogenesis
1、Pathology:The sac of lung hernia is the pleural parietal layer. The orifice of the cervical lung hernia is the fissure between the sternocleidomastoid muscle and the anterior oblique muscle, the orifice of the mediastinal lung hernia is the physiological weak point in the anterior upper and posterior lower parts of the mediastinal pleura, and the orifice of the chest wall (intercostal) lung hernia is the damaged and defective part of the chest wall. The contents of the hernia are lung tissue, and most belong to the 'sliding type', and it rarely occurs with an incarcerated hernia. When the lung hernia is small, it has no obvious effect on respiratory and other physiological functions; if the hernia mass is large, it can cause incarcerated or compressive symptoms, such as a large cervical lung hernia compressing the carotid artery and causing corresponding symptoms, etc.
2、Typing:According to the cause of onset and the location of herniation of the lung hernia, pathological typing is performed.
(1)Κατά κύριο λόγο, ο τύπος της κήλης μπορεί να διαχωριστεί σε δύο τύπους: κληρονομική κήλη και κληρονομική κήλη. Η δεύτερη περιλαμβάνει την τραυματική κήλη, την αυτοπροκαλούμενη κήλη και την παθολογική κήλη. Η παθολογική κήλη είναι συχνά η αιτία του όγκου ή της λοίμωξης.
(2Κατά κύριο λόγο, ο τύπος της κήλης μπορεί να διαχωριστεί σε τύπους ανάλογα με την τοποθεσία: υπάρχουν κήλες του λαιμού, κήλες του τοιχώματος του πνεύμονα (μεσοπλακειακή κήλη), κήλες του διαφράγματος και κήλες του μεσοθωρακίου, από τους οποίους η κήλη του λαιμού έχει την υψηλότερη συχνότητα εμφάνισης, αντιπροσωπεύει το50%~60%.