Adult presentation of symptomatic left lung agenesis

Anaesthesia Management for Neurosurgery in a Patient With Congenital Lung Agenesis

Congenital lung agenesis is a rare congenital abnormality associated with an absence or under-development of either one or both lungs, and its presentation in adulthood is even rarer. We describe a 40-year-old female patient with a history of congenital agenesis of the right lung and a high-grade glioma in the frontal region of the brain presenting for craniotomy and excision of the tumor in an MRI suite. Lung protective strategies of ventilation were utilized intraoperatively. The remote location of the MRI suite made access to extra manpower support challenging. The patient was managed uneventfully and discharged stable to the high-dependency unit. Our case describes how congenital lung agenesis poses a unique set of challenges for anaesthetic management, particularly in neurosurgical patients, and provides guidance to a multidisciplinary team approach.

Pneumonectomy in an elderly patient with congenital unilateral lung hypoplasia and recurrent Aspergillus: a case report

Background

Congenital lung disorders encompass a spectrum of several conditions, one of which is lung hypoplasia. While hypoplasia is typically identified and intervened upon in the neonatal period, some patients can remain asymptomatic or even be diagnosed as adults. Given the rarity of the condition persisting in adults though, it is not clear what medical or surgical interventions may be helpful if respiratory status declines.

Case Description

In this report, we describe an elderly man with a history of right lung hypoplasia, pulmonary artery agenesis, and bronchial atresia who developed progressive dyspnea and worsening cough. His condition was complicated by multiple Aspergillus infections for which he received prolonged courses of anti-fungal therapy. He was also treated for bacterial pneumonia many times over a 10-year period. However, as his symptoms remained refractory to medical management, he underwent pneumonectomy, which revealed diffuse cystic changes in the right lung. He is currently doing well post-operatively with resolution of his dyspnea.

Conclusions

Although hypoplastic lung disorders have been described in asymptomatic adults, this report highlights the successful utilization of pneumonectomy in an individual with refractory symptoms much later in adulthood. This case additionally describes possible complications of cystic lung disease in this patient population, serving as further rationale for aggressive intervention.

A rare variant of right sided pulmonary agenesis presenting in adulthood: 1st reported case from Bangladesh

Pulmonary agenesis is a rare disorder, and the right-sided one is much rarer. Most of the cases are diagnosed during early life. Because of rarity, it can be misdiagnosed and even more challenging to diagnose when presented during adult life.

However, we report a rare late manifestation of right-sided unilateral lung agenesis in a 22-year-old female patient who was treated for pneumonia several times, the first reported case from Bangladesh. We also highlighted the diagnostic approach of the case in low-resource settings.

Late presentation of unilateral lung agenesis in adulthood

Background

Pulmonary agenesis is a rare congenital anomaly with a reported prevalence of about 1 in 100,000 births. It may be bilateral or unilateral. Among the unilateral form, left lung agenesis is more common (70%); however, it is the right lung agenesis which carries a dismal prognosis due to the frequent association with a gamut of other congenital anomalies and greater degree of mediastinal shift leading to tracheo-bronchial and vascular distortion. The patients of unilateral pulmonary agenesis usually present in infancy or early childhood. Presentation in late adulthood as seen in our patient is rare. We present a case of left pulmonary agenesis that was diagnosed in 4th decade of life.

Case presentation

A 36-year-old male presented with gradually progressive exertional dyspnea of 1 month duration. Clinical examination revealed tachycardia and tachypnea. Chest radiograph showed opaque left hemithorax with ipsilateral mediastinal shift. Computed tomography clinched the diagnosis by demonstrating absence of left main bronchus, lung and left pulmonary artery with shift of heart, and great mediastinal vessels into left hemithorax. The patient was managed conservatively and discharged with attachment to out-patient department for regular follow-up.

Conclusion

Presentation of unilateral lung agenesis in late adulthood, as seen in the present case is extremely rare. This case report highlights that, a rare condition like unilateral pulmonary agenesis, should be considered in the list of differentials in an adult presenting with opaque hemithorax with ipsilateral mediastinal shift on radiography.

An adult patient presenting with right unilateral pulmonary agenesis: a case report and literature review

Pulmonary agenesis is a rare developmental defect in which there is complete absence of one or both lungs. Although the diagnosis is often made during childhood, asymptomatic patients can be diagnosed later due to the absence of comorbid anomalies. Chest radiography with an elevation of the hemidiaphragm and heart shifted to the right should make physicians suspicious for right lung agenesis. Here, we present a case report of a 53-year-old male with unilateral pulmonary agenesis of right lung found incidentally. He had a complaint of dyspnea. The respiratory system examination revealed no breathing sounds on the right side with normal breathing sounds on the left side. A posterior anterior chest radiograph revealed homogenous opacity of the middle and lower radiological lung zone with elevation of the right hemidiaphragm. In addition, the trachea and heart were shifted to the right side. Contrast-enhanced multidetector computed tomography revealed the absence of the right lung parenchyma, right main bronchus, and right main pulmonary artery and vein. The left lung had normal pulmonary vasculature, was hyperinflated, and partially extended to the right hemithorax. A pulmonary conus was formed by only the left pulmonary artery. No congenital anomalies were detected.

Butterfly Vertebrae: A Systematic Review of the Literature and Analysis

STUDY DESIGN

Systematic review (Level 4).

OBJECTIVE

To summarize the demographics, clinical presentations, and conditions associated with butterfly vertebrae.

METHODS

A systematic search was performed of multiple databases. A total of 279 articles were identified for screening. Case series or case reports of butterfly vertebrae with adequate clinical detail were complied.

RESULTS

Eighty-two total articles (109 patients) were selected for final inclusion. Sixty-one percent of patients presented with a single butterfly vertebra, while 39% were multiple. The most common location for butterfly vertebrae was T1. Fifty-six percent of cases were associated with a syndrome, the most common being spondylocostal dysostosis. The presence of multiple butterfly vertebra was strongly associated with a syndrome or additional anomalies (P < .001). Overall, the most common presenting complaint was low back pain. Seventy percent of patients had associated spinal disease. Other organ systems affected included musculoskeletal (43%), craniofacial (30%), neurologic (27%), cardiovascular (24%), genitourinary (23%), gastrointestinal (22%), laboratory abnormality (16%), and endocrine (9%).

CONCLUSIONS

This study is the largest collection of butterfly vertebrae cases to date. Butterfly vertebrae are associated with spinal deformity and multiple butterfly vertebrae may indicate a syndromic illness. Low back pain or disc herniation may occur with lumbar butterfly vertebrae however the etiology of this phenomena has not been rigorously explained. Many diseases and syndromes are associated with butterfly vertebrae.