PMC6197727_01
Plain film of the chest. Left pleural effusion and multicystic air-filled lesion at left pulmonary lower lobe with mediastinal shift to the right and hypoexpansion of the lung; bilateral radiological signs of RDS.
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They revealed the presence of a left pleural effusion together with a multicystic air-filled lesion at left pulmonary lower lobe with mediastinal shift to the right and hypoexpansion of the ipsilateral lung; bilateral radiological signs of RDS were also present (Fig. 1).
Plain film of the chest. Left hypertensive pneumothorax.
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MDCT of the thorax without contrast medium, lung window. Coarse air-filled lesion with thick irregular walls at the apical segment (VI) of the left lower lobe (red asterisks), determining contralateral shift of the mediastinum. Left PTX (green asterisks). Suspected communication between the lesion and the left pleural space (black arrow). Pulmonary consolidations with air bronchograms surrounding the lesion and widespread among omo and contralateral lung (RDS). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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Pulmonary consolidations with air bronchograms surrounding the lesion and widespread among ipsi and contralateral lung were also demonstrated, compatible with RDS clinical setting (Fig. 4).
MDCT of the thorax with contrast medium injection (a, c, e Mediastinum window. b, d, f Lung window) Persistence of the cystic lesion (c, e. red asterisks), showing thin walls, mixed air-fluid levels. The lesion extends from VI to IX e X segments and pleural joining angle is acute (45 ), suggesting lung origin than pleural. Split pleura sign and acute folding of visceral pleura (a), significant for loculated pleural empyema. Absence of vascular anomalies from the descending aorta (red X). Relevant reduction of bilateral consolidations. Persistence of pneumothorax in the antero-basal zone (e. yellow asterisks). (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
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At this time bilateral consolidations were almost completely solved, but hydro-PTX persisted in the antero-basal zone, with no clear cleavage plan from the lesion, that lied superiorly (Fig. 5).
Fifth left intercostal space thoracotomy (a). IV segment cystic lesion opened before removal (b) showing thin walls.
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The baby underwent thoracotomy at the 5th left intercostal space with exeresis of segment IX and X and of a cystic lesion of segment VI (Fig. 6).
Chest-CT 1 year post-surgery: complete resolution. Re-expansion of the residual segments of the left lower lobe, showing only some fibrotic bands and traction bronchiectasis, due to parenchymal and pleural scarring.
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The only evidence of parenchymal and pleural scarring was represented by a little number of dense fibrotic bands and traction bronchiectasis (Fig. 7).