Genetic and Developmental Disorders: Genetic Disorders |

Pseudohorseshoe Lung in an Adult FREE TO VIEW

Mei He, PhD; Shaoqiang Zheng, MD; Guangchao Hong, MD; Hanjing Lv, MD; Zhongmin Qiu, PhD
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Department of Respiratory Medicine, Tongji Hospital, Tongji University School of Medicine, Shanghai, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A245. doi:10.1016/j.chest.2016.02.255
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SESSION TITLE: Genetic Disorders

SESSION TYPE: Case Report Slide

PRESENTED ON: Saturday, April 16, 2016 at 02:15 PM - 03:45 PM

INTRODUCTION: Pleural separation of pulmonary lobes distinguishes pseudohorseshoe appearance from a true horseshoe lung. Acquired horseshoe appearance after the pulmonary diseases may have similar imaging findings to horseshoe lung. In this study, the imaging findings of pseudohorseshoe lung in an adult will be reviewed.

CASE PRESENTATION: In April 2014, a 24-year-old man went to hospital for a physical examination. He had not experienced orthopnoea and palpitation. He had no record of pulmonary diseases and rheumatic heart disease. Physical examination showed no pallor, icterus, cyanosis, clubbing, lymphadenopathy, oedema of the feet and raised jugular venous pulse. There was marked reduction in movement of the left hemithorax and evident left chest deformity, and the shift of the trachea and heart to the left. The entire left hemithorax, except the infraclavicular area, was dull on percussion. Breath sound was almost absent on the left side. A three-dimensional image of the lungs reconstructed from the CT scan showed that right lung herniated across to the left side resulting in a horseshoe shape, and the destroyed left lung (Figure).

DISCUSSION: A diagnosis of bronchiectasis with a destroyed left lung was made. Many diseases such as necrotizing pneumonia may cause a volume loss and a destroyed lung, or pseudohorseshoe lung. Acquired pulmonary diseases may lead to inflammatory conditions and fibrosis in the lung. The non-affected lobe may present compensatory hypertrophy. This may cause an acquired horseshoe appearance. Pseudohorseshoe lung results from the herniation of a basal segment of the right lobe. The herniated part may be attached or separated by the pleura [1]. In contrast, horseshoe lung is a rare congenital abormality characterized by the presence of a midline isthmus of the pulmonary parenchyma bridging the lungs. Pseudohorseshoe lung usually affects the pediatrics [2], and asymptomatic pseudohorseshoe lung is rarely diagnosed in adults [1].

CONCLUSIONS: Although it is very rare, pseudohorseshoe lung should be differentiated from other malformations [3].

Reference #1: Hawass ND, Badawi MG, al-Muzrakchi AM, al-Sammarai AI, Jawad AJ, Abdullah MA, Bahakim H: Horseshoe lung: differential diagnosis. Pediatr Radiol 1990;20:580-584.

Reference #2: Singh N, Agarwal R, Gupta D: Pseudohorseshoe lung. Cmaj 2008;178:394-394.

Reference #3: Sagawa M, Machida Y, Tanaka M, Motono N, Maeda S, Sakuma T, and Usuda K:Left Pulmonary Agenesis Showing Extraordinary Chest X-Ray Findings. Am J Respir Crit Care Med 2015;191:1083-1083.

DISCLOSURE: The following authors have nothing to disclose: Mei He, Shaoqiang Zheng, Guangchao Hong, Hanjing Lv, Zhongmin Qiu

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