The gradual appearance of a soft bulging prominence in one or both supraclavicular areas sometimes arouses a patient's apprehension. On examination, this bulge is neither indurated nor tender, and no definite mass can be palpated. When the patient coughs, strains or performs the Valsalva maneuver, the swelling expands considerably and a gentle outward positive impulse becomes perceptible. The bulging is usually symmetric but occasionally is unequal. A history of chronic cough for many years often is elicted, and many of these patients are emphysematous. This soft expansile mass is actually due to increased protrusion of the lung through the superior thoracic aperture, and is regarded as pulmonary apical herniation.
In our experience supraclavicular herniation of the lung is not unusual. Ninteen cases seen recently are reported here (Table). Nevertheless, references to this condition in the literature are meager, consisting mainly of individual case reports. Until 1946 only 185 cases
FENICHEL NM, EPSTEIN BS. Pulmonary Apical Herniations. AMA Arch Intern Med. 1955;96(6):747-751. doi:10.1001/archinte.1955.00250170053007