Opaque Hemithorax. Can We Ignore Pulmonary Aplasia As A Cause? – Case Report

Abstract

Congenital malformations of the lungs are rare disorders occurring with variable degree of severity. They are categorized as pulmonary agenesis, aplasia and hypoplasia with distinct clinical implications. The thoracic imaging appearance of pulmonary agenesis or aplasia consists of complete opacification of one hemithorax with severe volume loss evidenced by extensive shift of the cardiomediastinal structures toward the affected side. The complete absence of lung tissue and a pulmonary artery on the affected side confirms the diagnosis and may be best appreciated on thoracic computed tomography. Aplasia has been diagnosed during antenatal sonography but attempts to surgically correct the condition have not met with significant success. This paper describes the case of a young patient who had clinico-radiological evidence of severe hemithoracic volume loss (gross mediastinal shift and opaque hemithorax on chest radiograph) and had been treated for possible tuberculosis for long period of time without relief. CT examination confirmed absence of lung tissue on this side in the presence of a rudimentary bronchus, thereby confirming the diagnosis of pulmonary hypoplasia. It is stressed not to overlook the rare possibility of pulmonary agenesis/aplasia or hypoplasia whenever confronted with a skiagram of chest showing complete hemithoracic opacification.

Key words: CT of pulmonary hypoplasia, pulmonary aplasia, opaque hemithorax, Congenital lung malformations.