Unilateral Pulmonary “Emphysema”

Publisher Website
Google Scholar
Abstract
Increased radiolucency of one lung associated with decreased prominence of its hilar and pulmonary vascular markings is observed most commonly in obstructive emphysema due to occlusion of a main or lobar bronchus by a mass or foreign body and in compensatory emphysema following collapse of a pulmonary lobe or segment. Recently, however, there have appeared several reports describing a condition in which the roentgen findings simulate obstructive or compensatory emphysema but which proves on further roentgen examination to be neither. The first comprehensive analysis of a group of such patients was made by Macleod, who reported 9 cases under the title Abnormal Transradiancy of One Lung (2). Later Dornhorst, Heaf, and Semple (1), designating the process as “unilateral emphysema,” described 4 additional examples and reported follow-up studies on 5 of Macleod's original cases. Neither of these reports identifies the disease as one of the recognized forms of pulmonary emphysema. Actually the first case, in a boy of six years, was reported by Swyer and James, who entitled their paper A Case of Unilateral Pulmonary Emphysema but were careful to point out the clinical and roentgen features distinguishing the process from both compensatory and obstructive emphysema (6). Even though it may eventually prove to be incorrect, it seems preferable to designate the lesion as “emphysema” rather than as “abnormal transradiancy,” which is a purely roentgenographic description. The cardinal point of differentiation of unilateral “emphysema” from other forms of airway obstruction is the absence of major bronchial occlusion demonstrable by bronchography. In most of the patients movement of the mediastinum is toward the abnormal lung on inspiration, the opposite of what takes place in obstructive emphysema. The present paper describes a case which is representative of those previously reported. Case Report A 38-year-old male, a machinist, was referred for study in July 1955 because of an abnormal chest roentgenogram. He was asymptomatic except for occasional dry cough and mild exertional dyspnea. He gave a history of a severe respiratory illness in childhood which was diagnosed as “pneumonia” and treated at home, with no apparent sequelae. There were infrequent “colds” which cleared readily. The left hemithorax was hyperresonant and the breath sounds were decreased. Cardiovascular examination was normal. Roentgen study showed the left hemithorax to be slightly smaller and much more radiolucent than the right. There was a striking decrease in the vascular markings, with a corresponding decrease in the size of the hilar shadow on the left side. The right lung showed a marked increase in prominence of the vascular markings. There was minimal displacement of the mediastinal structures to the left side.

This publication has 0 references indexed in Scilit: