IJCRR - 6(15), August, 2014
Pages: 49-52
Date of Publication: 10-Aug-2014
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ISOLATED LEFT LUNG HYPOPLASIA IN AN ADULT- A CASE REPORT
Author: Vishnukanth Govindaraj, Manju R, Srinivas Banoth, Pratap Upadhaya
Category:
Abstract:Congenital anomalies of the lung occur due to various insults to the developing lung. Pulmonary hypoplasia is congenital
anomaly that can present either in isolation or with other anomalies. However they are not routinely considered in the differential diagnosis in adults. We present a case of isolated left lung hypoplasia in an adult who had no significant respiratory symptoms. We believe this case report would help in better understanding of this condition and help to create further interest in other similar conditions.
Keywords: Pulmonary hypoplasia, CT chest, Fiberoptic bronchoscopy
Full Text:
INTRODUCTION
Pulmonary hypoplasia is a developmental abnormality of the lung characterized by a decrease in the number of alveoli, cells, and airways with resultant decrease in size and weight of the lungs. Though predominantly a disease of infancy and childhood, its presentation in adults is not uncommon. Pulmonary hypoplasia has associated other congenital anomalies like renal agenesis,diaphragmatic hernia. Post natal diagnosis of this condition usually requires imaging studies and bronchoscopy. We present a case of isolated left lung hypoplasia in an adult who had few respiratory symptoms. The diagnosis was confirmed with fiberoptic bronchoscopy and computed tomography studies.
CASE SCENARIO
An asymptomatic 35 year old agricultural laborer presented with complaints of occasional left sided chest pain on moderate to severe exertion. He had no other respiratory complaints. He was not a smoker and had no co morbid illness. . He was first male child of a second degree consanguineously married parents. He is married since last 10 years and has two male children. He was initially evaluated outside for possible cardiac disease. His ECG showed no evidence of myocardial ischemia and he was referred to our respiratory medicine department for further evaluation. Upon presentation the patient was stable and maintained normal saturation at room air. There was no pallor or clubbing. Respiratory system showed trachea deviated to the left, diminished movements on the left side and a mild drooping of left shoulder. The apex beat was palpable in the left sixth intercostal space in mid axillary line. Breath sounds were absent in the lower left chest. Hematological investigations were within normal limits. Echocardiography showed a mild Tricuspid regurgitation. Spirometry revealed a mixed airway pattern. Chest x ray (fig. no 1) showed tracheal and mediastinal shift to left with crowding of ribs on the left upper zone with a hyper inflated right lung. A possibility of left lung collapse was suspected and he was planned for computed tomography(CT) of the thorax and fiber optic bronchoscopy. CT Scan Thorax (fig 2) revealed marked asymmetry in thorax. The right lung was hypertrophied and was observed to extend to the left hemithorax through anterior recess. The left lung showed a compressed left main bronchus with only minimal residual lung tissue. No endo-bronchial lesion was observed. Bronchiectatic changes were seen in the left lung tissue. The mediastinum was shifted to left side. The pulmonary arteries were normal. A possibility of left lung hypoplasia was considered and a fiber optic bronchoscopy(FOB) was performed. Bronchoscopy showed a normal trachea, carina and right side bronchial tree. The left main bronchus was narrowed and slit like in appearance. On negotiating the left main bronchus, left lobar bronchi were seen but
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