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Case 102

Left Pneumonectomy

White Lung Field

Dr Omar Bashir

A pre-operative chest radiograph was obtained for a 55 year old woman undergoing surgery for bowel cancer. The houseman was alarmed to find a totally white lung field.

Findings

1. Left hemithorax is opacified.
2. The mediastinum is shifted to the left (note the trachea and the heart).
3. Left hemi-diaphragm is not visible.
4. A segment of the left 5th rib is missing.

Diagnosis

Left Pneumonectomy

Differential

Other causes of opacification of lung field:

1. Large pleural effusion
2. Collapse
3. Consolidation
4. Congenital absence/hypoplasia of one lung (rare)

Discussion

Post pneumonectomy chest film appearance could cause diagnostic difficulty if the history of the procedure is not available. Look for rib deformity as this would indicate thoracic surgery.

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