Axial CT image showing an intercostal thoracic left lung herniation. This occurred following a mini-thoracostomy for epicardial lead placement. In the post-operative period, he developed lung herniation with incisional left chest swelling and pain during Valsalva manoeuvres. The hernia progressively enlarged over 4 years to this size. Patient underwent left thoracotomy with reduction of the hernia, excision of the hernia sac, and pericardial patch repair of the intercostal defect. Surgically related lung herniation is reported more often with less invasive surgeries such as VATS lobectomy and thoracostomy vs. thoracotomy and is a rare but important complication of thoracostomy.