An 11 year old boy with a right hemithorax deformity and diminished breathing sounds in the right lung was referred to our department, following examination by a physician due to knee pain caused by flat-footedness. He had a history of recurrent viral infections of the upper airways in early childhood since the age of 3 yrs. He has been free of pulmonary complaints. Bronchitis was diagnosed only once. Pregnancy and delivery were normal. In the neonatal and infantile period the boy was in good health. The right hemithorax deformity was diagnosed at 4 yrs of age, but was interpreted as a complication of rachitis.On physical examination, the patient appeared well. He was thin (weight 24 kg, height 134 cm; 25th and below 3rd percentiles, respectively), had a markedly enlarged right hemithorax with a slight reduction of wall
CASE FOR DIAGNOSIS. movement, respiratory rate 16 breaths·min -1 , blood pressure 110/70 mmHg, and pulse rate 80 beats·min -1 . Heart sounds were normal. Lung auscultation revealed weakness of breathing sounds over the right lung field. Intensification to percussion was noted over the lower two thirds of the right hemithorax. Clubbing was not observed. In laboratory evaluation and blood gas analysis, no abnormality was found. An electrocardiogram revealed incomplete right bundle branch block. Pulmonary function tests showed forced expiratory volume in one second (FEV1)=74% of predicted value and vital capacity (VC)=77% pred; all other parameters (including residual volume (RV) 132% pred, functional residual capacity (FRC) 106% pred, total lung capacity (TLC) 91% pred, and flow-volume curve) were normal. The patient's exercise activity was normal. A chest radiograph and computed tomography (CT) scan, are shown in figures 1 and 2.Fibrebronchoscopy revealed a small diverticulum (depth 2 mm) at the site of the right ninth segmental bronchus. Bronchial culture was negative. The right bronchographs are shown in figure 3a and b.