Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

QUIZ
Year
: 2001  |  Volume : 11  |  Issue : 3  |  Page : 145--146

Radiological quiz - chest


KS Sodhi, A Tirath, S Suri 
 Dept of Radiodiagnosis, PGIMER, Chandigarh, India

Correspondence Address:
K S Sodhi
House No 1181, Sector - 37-B, Chandigarh
India




How to cite this article:
Sodhi K S, Tirath A, Suri S. Radiological quiz - chest.Indian J Radiol Imaging 2001;11:145-146


How to cite this URL:
Sodhi K S, Tirath A, Suri S. Radiological quiz - chest. Indian J Radiol Imaging [serial online] 2001 [cited 2020 Feb 19 ];11:145-146
Available from: http://www.ijri.org/text.asp?2001/11/3/145/30560


Full Text

M fifteen-years-old boy with a history of operated post-traumatic extradural hemorrhage (EDH), presented with cough and chest pain for the last seven days. There was no history of fever or hemoptysis. There was no history of any significant respiratory or other illness or of aspiration of a foreign body. Examination of the respiratory system revealed decreased breath sounds on the left side. The rest of the systemic examination was unremarkable. A radiograph [Figure 1] and contrast enhanced CT of the chest [Figure 2],[Figure 3] are shown below.

Radiological Diagnosis

 View Answer

 PULMONARY APLASIA



The chest radiograph [Figure 1] shows homogeneous opacification of the left hemithorax with gross displacement of the heart, trachea and mediastinal structures to the left. Compensatory hyperinflation of the right lung along with herniation across the midline is also seen.

CT [Figure 2],[Figure 3] confirms these findings and shows a small rudimentary left main bronchus, which could not be traced, distal to its origin. The lung parenchyma is absent on the left.

The radiological diagnosis of pulmonary aplasia was considered and the patient underwent flexible fibre-optic bronchoscopy, which revealed that the left main bronchus was small and uniformly narrowed confirming the diagnosis of pulmonary aplasia.

Congenital absence of the lung is a rare anomaly and is broadly classified under these categories - pulmonary agenesis, aplasia and hypoplasia [1]. In pulmonary agenesis, the lobe as well as its bronchus are completely absent. In pulmonary aplasia, the lung tissue is absent but a rudimentary bronchus is present, (as seen in our patient), whereas in pulmonary hypoplasia, bronchi and pulmonary tissues are present but are under-developed [1]. Bilateral pulmonary agenesis is extremely rare and is incompatible with life. The exact underlying pathogenetic mechanism is not known. An imbalance is thought to occur between the developing lung bud and the surrounding mesenchyme resulting in a deficit of mesenchyme around the airway bud of one lung [2],[3].

Differential diagnosis includes total atelectasis, pulmonary agenesis, pulmonary hypoplasia / aplasia and post pneumonectomy.

In an analysis of 156 patients, agenesis was found to be more common on the right side and a higher incidence was reported in women [4]. Patients with unilateral pulmonary involvement, are often asymptomatic, diagnosed by chance, (as our patient was) and are known to survive well into adulthood [5]. Recurrent respiratory infections may occur in infancy.

Associated abnormalities may be present is more than 50% of patients and include cardiovascular, gastrointestinal, skeletal, genitourinary and other anomalies [4],[5],[6]. A chest radiograph reveals an opacified hemithorax on the affected side with displacement of mediastinal structures, trachea and heart towards the affected side. Diagnosis of pulmonary aplasia can be established by bronchoscopy, bronchography and CT. Prognosis in patients with pulmonary aplasia depends on the severity of associated findings and the presence or absence of recurrent chest infections [6]. In the absence of any significant associated anomaly or functional decomposition of the normal lung, these patients usually carry a good prognosis [5].

References

1Felson B. Pulmonary agenesis and related anomalies. Semin Roentgenol 1972; 7: 17-30
2Reid L.M. The lung: its growth and remodelling in health and disease. AJR 1977; 129: 777-88.
3Reid L.M. Lung growth in health and disease. Br. J. Dis. Chest 1984; 78: 113-34.
4Maltz DL, Nadas AS. Agenesis of the lung: presentation of eight new cases and review of literature. Pediatrics 1968; 42: 175-188.
5Arora VK, Bedi RS, Sarin NK. Aplasia of the lung: a case report. Lung India 1986; 4: 171-174.
6Kesalar P, Newman B. Radiographic manifestations of anomalies of the lung. Radiol Clin North Am 1991; 29: 255-270.