PMC6159179_01
Serial CXRs (a, b and c) showing hyperlucent left hemithorax with progressive reticular shadowing and volume loss of the right middle and lower lobes.
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An initial chest radiograph 2 years prior to presentation suggested an increased radiolucency of the left lung but this was not investigated further (Figure 1a). Serial CXRs 2 years later showed a relatively unchanged appearance of the left hemithorax with progressively increased opacification in the periphery of the middle and lower zones, and accompanying reduction in lung volume, on the right side (Figure 1b,c).
Contrast-enhanced CT of the chest shows hypoplastic left pulmonary artery (a, arrow), reduction in the number and size of the peripheral pulmonary artery branches on the left (b, arrows), translucent left lung with cystic bronchiactasis of the lingula and left lower lobe (c, d). The right lung shows volume loss, extensive subpleural reticulation with lower lobe predilection (c, d) and traction bronchiectasis (d, arrow).
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Her CT showed hypoplastic left pulmonary artery (Figure 2a; arrow), attenuated peripheral pulmonary artery branches on the left (Figure 2b: arrows), hyperinflated left lung with air trapping and cystic bronchiectasis of the lingua and left lower lobe (Figure 2c,d). Interestingly, the right lung was small in size with evidence of subpleural reticulation, traction bronchiectasis and ground-glass opacification suggesting an underlying pulmonary fibrosis (Figure 2c,d).
PET CT for investigation of an unrelated pathology demonstrates oligaemia of the left hemithorax with generalized reduction in FDG uptake (a and b).
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The oligaemia of the left lung is shown as reduced FDG uptake (Figure 3) on PET CT, which was done to investigate a different pathology.