Pulmonary Hernia in an Infant with Hepatic Osteodystrophy: A Novel Cause of Dyspnea

Background Pulmonary herniation is a rare condition where the lung parenchyma protrudes beyond the confines of the thoracic cavity. It is categorized as either congenital or acquired, with acquired subdivided into spontaneous, traumatic, and pathologic. In pediatric patients, pulmonary hernias are typically congenital, related to agenesis of the ribs or sternum, or traumatic. While pulmonary hernia has been described in other chest wall diseases, it has not been described in the setting of hepatic osteodystrophy. In this condition, osteopenia results when chronic cholestasis causes vitamin D and calcium malabsorption, resulting in secondary hyperparathyroidism and rickets. We present a case of an infant female with hepatic osteodystrophy undergoing work-up for respiratory distress, incidentally, found to have an anterior thoracic pulmonary hernia contributing to symptoms of dyspnea.