PMC9666727_01
Chest radiographs, computed tomography and 3D CT reconstruction before surgery. (A) Chest radiographs, revealing that the trachea and mediastinum were shifted to the right. (B) Coronal chest CT images, indicating the absence of a horizontal fissure anterior to the aorta, with anterior herniation of the left lung crossing the midline. (C, D) 3D reconstruction of CT images, showing (C) only two lobes of the right lung and (D) complete absence of lung tissue from the right upper lobe, including the lung parenchyma, pulmonary vessels and bronchial tree.
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There were only two lobes in the right thoracic cavity, and the entire right upper lobe, including the lung parenchyma, pulmonary vessels and bronchial tree, was completely absent ( Figure 1 ).
Computed tomography and bronchoscopy examination of the bronchi before surgery. (A, B) Axial (A) and coronal (B) chest CT images, showing the bronchus of the right upper lobe as a bud. (C) 3D CT reconstruction, indicating that the bronchus of the right upper lobe was a terminal cecum, and that the bronchial tree had not formed at the distal end. (D) Bronchoscopy examination, confirming the undeveloped bronchial primordium and ruling out a secondary obstruction.
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In addition, 3D CT reconstruction and bronchoscopy confirmed that the bronchus of the right upper lobe was a terminal cecum, ruling out secondary obstruction due to bronchial stenosis or intrabronchial neoplasm ( Figure 2 ).
Chest CT, bronchoscopy and pathologic examination of the mass in the right lower lobe. (A, B) Axial images of chest CT, revealing a mass approximately 5 cm in diameter in the right lower lobe adjacent to the hilum (arrows). (C) 3D reconstruction revealing that the mass was adjacent to the hilum and invaded the surrounding vessels, indicating the mass was a malignancy. (D) Bronchoscopy results, showing a neoplasm (arrow) in the bronchus of the right basal segment. (E) Hematoxylin-eosin staining showing the complete absence of normal alveolar structure, replaced by growing cancer cells with enlarged nuclei and cloudy cytoplasm. (F) Immunohistochemical staining with antibodies to TTF-1, indicating that the tumor cells positively expressed TTF-1. The combined results of HE staining and immunohistochemistry indicated that the mass in the right lower lobe was an adenocarcinoma.
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Bronchoscopy examination discovered a neoplasm in the right basal section, and the pathological type of biopsy was adenocarcinoma ( Figures 3A-D ). Immunohistochemical staining of tumor indicated that NapsinA, TTF-1, CK7 were positive expression and CgA, Syn, CD56 were negative expression ( Figures 3E, F ).
Chest computed tomography and7 3D CT reconstruction after surgery. (A) Chest CT, revealing that the trachea and mediastinum were more obviously shifted to right than that before surgery. (B) Coronal chest CT images, indicating adequate recruitment of the right middle lobe. (C, D) 3D reconstruction of CT images, showing (C) only middle lobe in right thoracic cavity and (D) unobstructed bronchus of right middle lobe.
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Postoperative chest CT and 3D reconstruction indicated more pronounced mediastinal shift toward right and adequate recruitment of the right middle lobe ( Figure 4 ).