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An unusual case of unilateral hyperlucent lung

Richa Mittal, Rohit Kumar, A. J. Mahendran, Manas Mengar, Shibdas Chakrabarti
Breathe 2020 16: 200071; DOI: 10.1183/20734735.0071-2020
Richa Mittal
Dept of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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  • ORCID record for Richa Mittal
Rohit Kumar
Dept of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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  • For correspondence: dr.rohitkumar@mail.com
A. J. Mahendran
Dept of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Manas Mengar
Dept of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Shibdas Chakrabarti
Dept of Pulmonary, Critical Care and Sleep Medicine, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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    Figure 1

    Posteroanterior chest radiograph showing increased translucency of the left hemithorax with displacement of mediastinal structures to the contralateral side.

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    Figure 2

    Axial section of the chest CT at the level of the main carina showing shift of mediastinum to right side and hyperinflation of left lower lobe and compression of adjacent parenchyma.

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    Figure 3

    a and b) Coronal sections of the chest CT showing hyperinflation of left lower lobe with displacement of oblique fissure and compression of adjacent upper lobe. Vascular markings are noted inside the hyperinflated lungs and are attenuated.

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    Differential diagnosis of unilateral hyperlucent lung

    Anatomical siteRadiological and supportive findingsAbnormalities
    1.Technical issueHyperlucency on the side to which patient is rotatedRotation
    2.Chest wallNormal vasculature of hyperlucent sidePoland syndrome (hypoplasia of pectoralis muscle)
    Mastectomy
    3.Pleural spacesThin sharp pleural line with no vascular markings peripheral to itPneumothorax
    4.Parenchymal defectObstructive hyperinflation: hyperlucent lung with spreading and narrowing of pulmonary vessels
    Characteristic appearance: at full expiration normal lung volume decreases whereas the diseased side volumes remain fairly similar
    Compensatory hyperinflation: small or normal sized hyperlucent lung, spreading of the vascular markings and displacement of the ipsilateral hilum with normal decrease in volume of lung in the expiratory films
    Congenital lobar emphysema
    Swyer–James–MacLeod syndrome
    Unilateral bullous emphysema or cystic lung diseases
    Atelectasis/lobectomy
    5.Vascular defect: congenitalHyperlucent lung, a small hilum, poor vascularisation, and ipsilateral shift of the mediastinum
    Normal reduction in lung size on expiration
    Aplasia of a pulmonary artery (its proximal interruption) and pulmonary hypoplasia
    Vascular defect: acquiredUnilateral hyperlucent lung with no evidence of air trapping on both inspiratory and expiratory radiographs
    Normal sized lung and the ipsilateral hilum is normal size/ enlarged
    Pulmonary thromboembolism, fibrosing mediastinitis, sequelae of mediastinal irradiation
    6.Airway defectAbnormally large affected side even in expiratory film
    Obstruction in spirometry
    Unilateral obstruction: bronchial atresia, extrinsic and intrinsic causes of bronchial compression (such as a foreign body), endobronchial tumours
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An unusual case of unilateral hyperlucent lung
Richa Mittal, Rohit Kumar, A. J. Mahendran, Manas Mengar, Shibdas Chakrabarti
Breathe Dec 2020, 16 (4) 200071; DOI: 10.1183/20734735.0071-2020

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An unusual case of unilateral hyperlucent lung
Richa Mittal, Rohit Kumar, A. J. Mahendran, Manas Mengar, Shibdas Chakrabarti
Breathe Dec 2020, 16 (4) 200071; DOI: 10.1183/20734735.0071-2020
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