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Weekly Chest CasesArchive of Old Cases

Case No : 914 Date 2015-05-04

  • Courtesy of K N NAGABHUSHAN, CICY KUNCHERIA, SHAMEEM AHMED, JOY P VERGHESE / MES medical college and hospital. Kerala, India
  • Age/Sex 26 / M
  • Chief ComplaintDyspnea on exertion for ten years, cough and chest pain for 7 days
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4

Diagnosis With Brief Discussion

Diagnosis
UNILATERAL HYPOPLASIA OF THE LUNG
Radiologic Findings
Fig 1. Chest roentgenogram shows radio-opacity in the left hemithorax with a mediastinal shift to the same side. Crowding of ribs can be seen on the left side.
Fig 2. Lung window setting of the chest CT scan shows bronchiectatic changes in the small opaque left lung. Compensatory hyperinflation and herniation of the right lung can be seen through the anterior recess.
Fig 3. Mediastinal window setting of the chest contrast CT scan shows the main pulmonary artery and its branches. The left branch of main pulmonary artery is hypoplastic and supplies the herniated right lung.
Fig 4. Mediastinal window setting of the chest contrast CT scan shows right-sided superior and inferior pulmonary veins draining into the left atrium. No demonstrable pulmonary veins can be seen on the left side.
Brief Review
Unilateral lung hypoplasia can be primary (idiopathic) or due to secondary causes such as reduced hemithoracic volume, reduced pulmonary perfusion, or reduced fetal respiratory movement (1). Unilateral lung hypoplasia can clinically remain silent until adulthood and is often diagnosed incidentally for non-specific chest complaints (2). Radiological findings in these cases are a marked decrease in the hemithorax with an ipsilateral mediastinal shift and compensatory hyperinflation of the contralateral lung. Aplasia/hypoplasia of pulmonary vessels, bronchi are demonstrated in many cases(1). Typically, the rudimentary lung shows bronchiectatic changes within. Differential diagnoses include severe bronchiectasis with collapse, fibrothorax and atelectasis from other causes. Other differential diagnoses include Swyer James syndrome characterized by a hyperlucent lung with air trapping and Congenital veno-lobar syndrome (Schimitar syndrome) with a hypoplastic lung and the classical 'scimitar' syndrome of an anomalous pulmonary vein draining into the systemic vein (2).
References
1. Kant S. Unilateral pulmonary hypoplasia – a case report. Lung India 2007; 24 : 69-71.
2. Georgescu A, Nuta C, Bondari S. “3D Imaging in Unilateral Primary Pulmonary Hypoplasia in an Adult: A Case Report,” Case Reports in Radiology, vol. 2011, Article ID 659586, 6 pages, 2011. doi:10.1155/2011/659586.
Keywords
Lung, Congenital,

No. of Applicants : 110

▶ Correct Answer : 83/110,  75.5%
  • - The University of Tokyo Hospital , Japan Akifumi Hagiwara
  • - Osaka Rosai Hospital , Japan Hiromitsu Sumikawa
  • - NIMS, HYDERABAD , India bhaskar kakarla
  • - McGill , Canada ilan azuelos
  • - Yokohama-asahi-chuo-general hospital , Japan Kyoko Nagai
  • - MBAL BURGAS , Bulgaria VLADISLAV RUSINOV
  • - CHRU Lille , France Julien Pagniez
  • - Diskapi Yildirim Beyazit Hospital, Ankara , Turkey Meric Tuzun
  • - University of British Columbia , Canada Amr Ajlan
  • - Bahcesehir University School of Medicine, Radiology Department , Turkey Mustafa Kemal Demir
  • - Hospital Universitario y Politecnico La Fe , Spain Carlos Munoz-Nunez
  • - GHICL , France manuel toledano
  • - Korea university , Korea (South) Kun Woo Kang
  • - Myongji hospital , Korea (South) Ji Ye Lee
  • - Pusan National University Yangan Hospital , Korea (South) yoonyoung choi
  • - UZA , Belgium Eline De Smet
  • - Kilpauk medical college , India abirami mahadevan
  • - PRINCE SATTAM IBN ABDULAZIZ UNIVERSITY HOSPITAL , Saudi Arabia Elbagir Nasser
  • - Chonnam national university hospital , Korea (South) Wongi Jeong
  • - McGill University Health Center , Canada Alexandre Semionov
  • - Chonnam Nationl University Radiology , Korea (South) KIM JU WON
  • - SQUH , Oman Saleh Baawain
  • - �stanbul , Turkey Ayhan Yilmaz
  • - Pneumologia Universitaria, Policlinico di Bari , Italy Mario Damiani
  • - Oita University, Faculty of Medicine , Japan Fumito Okada
  • - Deptt of Radiodiagnosis & Imaging, PGIMER chandigarh , India Ram Galwa
  • - Diagnose.me (BV) / Royal Perth Hospital , Australia Yuranga Weerakkody
  • - Niigata City General Hospital , Japan Takao Kiguchi
  • - The University of Tokyo Hospital , Japan Takeyuki Watadani
  • - Okinawa Kyodo Hospital , Japan Shoko Iraha
  • - university of montreal , Canada Andrei Gorgos I
  • - Onomichi Municipal Hospital , Japan Yoshihisa Masaoka
  • - Dong-A University Hospital , Korea (South) Won Jin Choi
  • - Marine medical corps , Korea (South) Hyorin Kim
  • - Emory University Department of Radiology , United States Travis Henry
  • - Emory University Hospital , United States Scott Hamlin
  • - Asan medical center , Korea (South) Sang Young Oh
  • - Chonnam National University Hwasun Hospital , Korea (South) Yunhong Yoon
  • - CCN , France Vincent Barrau
  • - kyungpook national university , Korea (South) Chungeun Lim
  • - Seirei Hamamatsu General Hospital , Japan Kenichi Mizuki
  • - Asan Medical Center, Ulsan University , Korea (South) Mi Young Kim
  • - Ishikawa Matto Central Hospital , Japan Manabu Akimoto
  • - MT agarwal hospital,Mulund, Mumbai , India ASHISH SARODE
  • - The University of Tokyo , Japan Eisuke Shibata
  • - Ondokuz Mayis University , Turkey Cetin Celenk
  • - Kizawa Memorial Hospital , Japan Yo Kaneko
  • - Ewha Womans University Hospital , Korea (South) YOOKYUNG KIM
  • - DAYA General Hospital,Thrissur,Kerala , India Raveendran TK
  • - McGill University Health Center , Canada Matthieu Storme
  • - Otsu Red Cross Hospital , Japan Hirotsugu Nakai
  • - chungbuk national university hospital , Korea (South) soojung lee
  • - 異⑸ , Korea (South) Yunhee Jang
  • - Onomichi municipal hospital , Japan Hirofumi Mifune
  • - National Center hospital of Neurology and Psychiatry , Japan Kaoru Sumida
  • - Niigata University , Japan Atsushi Uehara
  • - Northern Yokohama Showa university , Japan Kota Watanabe
  • - IRSA La Rochelle , France Denis Chabassiere
  • - Fortis hospital , Mohali , India Shaleen Rana
  • - IRSA LA ROCHELLE , France, Metropolitan BIGOT
  • - Pamukkale University, Faculty of Medicine, Dept. of Radiology , Turkey Furkan Ufuk
  • - Gifu Central Hospital , Japan Haruo Watanabe
  • - VHS medical center , Korea (South) Keuntak Roh
  • - NASA SCANS , India RAKESH BHATIA
  • - Kizawa Memorial Hospital , Japan Shoji Okuda
  • - jaslok hospital & research centre mumbai , India JAINENDRA JAIN
  • - ALHAYAH SCAN RADIOLOGY CENTER , Egypt Elsayed Mousa
  • - CLINIQUE STE CLOTILDE , Reunion patrick MASCAREL
  • - Pusan national university hospital , Korea (South) Jin Joo Kim
  • - 遺€ , Korea (South) LEE YOU JIN
  • - Nagasaki University Hospital, Department of Pathology , Japan TOMONORI TANAKA
  • - Pusan national university hospital , Korea (South) Ji Bae
  • - pusan national university hospital , Korea (South) kim jeongmyeong
  • - Pusan national university hospital , Korea (South) Hie Bum Suh
  • - Pusan university yangsan hospital , Korea (South) Jeong JIN
  • - Pusan national university hospital , Korea (South) Minkyu Kwak
  • - PNUH , Korea (South) Seungbaek Hong
  • - Pusan national university hospital , Korea (South) SeungHyun Lee
  • - Busan national univercity hospital radiology department , Korea (South) Il-wan Son
  • - Medicheck health care , Korea (South) Chae Lim
  • - Asan Medical Center , Korea (South) Jooae Choe
  • - Wuhan Union Hospital , China Qiguang Cheng
  • - CNUH , Korea (South) Noh Hoon
▶ Correct Answer as Differential Diagnosis : 8/110,  7.3%
  • - Hanyang universitiy, radiology department , Korea (South) HyunGyu Lee
  • - Avrasya Hospital , Turkey Murat Ulusoy
  • - Madras Medical College , India bommu samy
  • - chungbuk university hospital , Korea (South) Hyeonmi Ryu
  • - chp st martin , France Mariotte benoit
  • - CHU Poitiers , France CHAN paul
  • - Okayama University Hospital , Japan Toshiyuki Komaki
  • - Armed Force Seoul Hospital , Korea (South) Eui Jin Hwang
▶ Semi-Correct Answer : 4/110,  3.6%
  • - Ajou University hospital , Korea (South) Hun Cho
  • - Asan Medical Center , Korea (South) Soyeoun Lim
  • - Asan , Korea (South) Sania ALBlushi
  • - ZIGONG TCM HOSPITAL OF CHINA , China Cao Cunyou
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