PMC3350092_01
PMC3350092_02
PMC3350092_03
The radiological aspect could suggest a left basal pachypleuritis and a left lower lobe atelectasis, with ipsilateral mediastinal deviation and right lung herniation (a); 3D bone reconstruction revealed a symmetrical thoracic cage, discordant with an acquired retractile pleural-pulmonary pathology (b).
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fig1
The posterior-anterior chest roentgenogram offered an erroneous diagnosis, presenting an apparently opacity in the left lower pulmonary zone, a hypoaerated upper left lobe and left deviation of the mediastinum, as we present in this CT scanogram (Figure 1(a)). We can mention that despite the apparent atelectasis of the left lung, there is not a significant retraction of the left hemithorax, such as in the postnatal acquired pathology (Figure 1(b)).
The axial scans in lung window imaging reconstruction before (a) and after (b) the left pneumonectomy.
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fig2
The axial scans in lung and mediastinal windows images (Figures 2 and 5(a)) were considered essential for the counting of the bronchial segmentation range, but not enough for the understanding of the anatomical compensatory development of the right lung and of the mediastinal structures.
The coronal (a) and sagittal (b) reconstructions in mediastinal window imaging allow a better understanding of the anatomical position of the supra- and underdiaphragmatic organs.
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fig3
3D Reconstructions in the "surface" mode visualize both the hypoplastic dysplastic left lung, with multicystic architecture of small range segmentation (a), and the right hypertrophic lung with the pleural fissures and the abnormal lobar orientation (b). The upper lobe is in the left-posterior location, the middle lobe is in the left-anterior position, and the lower lobe is emptying the retrosternal space and the right hemithorax. The mediastinal space is reduced and posterior located, surrounded by the "horseshoe" right lung.
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fig4
For the reconstructions we maintained conventionally the left lobe on the left-side of the screen in the posterior-anterior view, for better recognition when comparing with the axial and the coronal scans (Figure 4). 
Contrast MDCT illustrates the apparent blind-ended hypoplastic left pulmonary artery (black arrow) and the dilated right pulmonary artery (a); coronal reconstruction visualizes the hypoplastic left pulmonary artery (b), and 3D reconstruction in the "transparency" mode (c) demonstrates the main bronchial orientation, the cystic structure of the left lung and the presence of the functional vascular architecture only in the developed lung (white arrow).
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fig5
The axial scans in lung and mediastinal windows images (Figures 2 and 5(a)) were considered essential for the counting of the bronchial segmentation range, but not enough for the understanding of the anatomical compensatory development of the right lung and of the mediastinal structures.
Postoperatory MDCT with 3D view reconstruction showing the blind-ended left main bronchia and the compensatory hyperplasic right lung.
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fig6