Fig. 1: First CXR showing right hyperlucency with left-ward herniation
and compression of left lung.
A new chest x-ray showed the previously noted hyperlucency occupying the
entire right hemithorax and herniating to the left and compressing the
left lung. (Fig 2) The trachea was deviated to the left and no lung
markings were visible on the right. The differential diagnoses included
congenital pulmonary airway malformation (CPAM), congenital lobar over
inflation (CLO) and vascular sling. Acquired causes like foreign body
and extrinsic lymph node compression, with ball-valve effect and
unilateral airway trapping were also entertained. A contrasted CT
confirmed the right-sided hyperlucent lung with herniation to the left
and left tracheal deviation. In addition, a small compressed right lung
could be visualised on the axial lung field view. (Fig 3) The left lung
was also compressed. Mediastinal lymph nodes and vascular rings were
excluded on mediastinal windows. His blood work-up was unremarkable.