A 52-year-old woman presented with bilateral soft, reducible anterior neck swellings on coughing, following a recent respiratory tract infection. Plain x-rays of the neck and upper chest showed a normal appearance. Computed tomography of the neck and chest while the patient performed the Valsalva manoeuvre showed bilateral large apical lung hernias, which extended through the thoracic inlet into the root of the neck (Figure). This lung herniation was probably caused by a congenital deficiency in the suprapleural membrane (Sibson’s fascia), combined with increased thoracic pressure created by the respiratory tract infection. Surgical repair was not necessary as the hernias were asymptomatic and not associated with chronic cough.
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Acknowledgement: I thank Dr Bhavin Jankharia, Consultant Radiologist, JIC, Mumbai, India, for the computed tomography image.