Chest X-ray showing Total Homogenous Opacification of the Right Hemithorax with Gross Mediastinal Shift
towards the Left
There were two major causes for respiratory distress in this case, one being the mediastinal shift
caused by the unilateral lung agenesis and other being the presence of tracheal rings causing tracheal stenosis.
In these patients, problems including polyhydramniosis, lung hypoplasia and mediastinal shift
can be determined by USG (2).
Chest X-Ray revealed increased lucency over the left hemithorax with visible lung markings and fluid level, suggestive of a large cystic structure, along with mediastinal shift
to the right.
Abnormal radiographic findings that suggest AFA include Asymmetry in lung expansion, mediastinal shift
, obstructive emphysema, opacification, atelectasis, consolidation, or finding a radiopaque foreign body.
However, we do not agree with the authors regarding their diagnosis of Swyer-James Syndrome, but feel that it is more consistent with destroyed left lung secondary to pulmonary TB and compensatory left sided- mediastinal shift
of right lung.
As air continues to build up, it may cause a mediastinal shift
, decreased cardiac output, and death.
CT scans of the thorax and abdomen showed multiple air-filled bowel loops with mesentery in the right hemithorax causing significant mediastinal shift
to the left (Figure 1).
3) PNP causes a mediastinal shift
and paradoxical movement of the diaphragm, resulting in alveolar hypoventilation and atelectasis on the affected side and more pronounced when supine.
This combination of anomalies, along with right upper lobe atelectasis and left-sided hyperinflation, resulted in a severe right mediastinal shift
and respiratory distress.
Chest radiographs demonstrated complete opacification of the right hemithorax with a mediastinal shift
to the left.
The left lung was normal in appearance with a mediastinal shift
to the left.