Hypoplasia of lung a rare entity mimicking as a case of tuberculosis

Abstract

Pulmonary hypoplasia, a congenital malformation, is characterized by incomplete development of the lungs, leading to an abnormally less number or dimensions of bronchopulmonary segments / alveoli resulting in small fibrotic and nonfunctional lung. It is usually diagnosed in the neonatal period or in early childhood. Hypoplasia may be primary (idiopathic) or secondary. Primary pulmonary hypoplasia, not related to other congenital anomalies is extremely seldom diagnosed in adults. We report the case of a 32-year-old married female with two kids presented to us with chief complaints of cough and fever for past nine months. Chest radiograph showed opacification of the left hemi-thorax with decrease in its size and marked ipsilateral mediastinal displacement with an increase in volume of right lung. After investigations she was diagnosed as a case of left lung primary pulmonary hypoplasia. High level of excellent clinical judgement needed to spot and diagnose this congenital aberration, often wrongly diagnosed in adults. Hence, once confronted with an opaque hemi-thorax in a young person with ipsilateral shift of the mediastinum, differential diagnosis of "lung hypoplasia" ought to be kept in mind.

Unilateral Pulmonary Hypoplasia in an Adult Nigerian: A Case Report and Literature Review

“…9 Contrast enhanced CT (CECT) is sufficient for the diagnosis of hypoplasia of the lung. 6 Plain radiographs demonstrate decreased aeration of the affected hemithorax and a small thoracic cage. A common finding is a shift of the mediastinum to the side of the hypoplasia, accentuated during inspiration due to increased compensatory ventilation of the other lung.…”

“…Hypoplasia: (Type 3) is presence of variable amounts of pulmonary parenchyma, bronchi, and supporting vessels. 6 Monaldi categorizes developmental disorders of the lung to four categories. Group I: No bifurcation of trachea; Group II: Only rudimentary main bronchus; Group III: Uncompleted development after bifurcation of the main bronchus; Group IV: Incomplete development of small segment and subsegmental bronchi of the corresponding lobe.…”

“…7 However, it may be infrequently present in adults not producing any symptoms thus rendering its diagnosis problematic. 6 Clinical course (severity of symptoms and their time of occurrence) is decided by the degree of hypoplasia present in the patient. 4,8 Our patient presented late in middle age with mild symptoms.…”