| Findings: Plain film radiography (figure 1): 1. Left side deviation of mediastinum.
2. Decreased opacity of the right lung compared to left lung.
Multidetector row CT scan of chest with intravenous contrast, and
with multiplanar reconstruction, maximum-intensity projection,
minimum-intensity projection, 3D volume rendering, and colored
multiplanar reconstruction (figure 2-7):
1. Relative hyperinflation of right upper lobe lung and lateral
segment of right middle lobe lung with distended alveoli and
decreased caliber of its vessels, suggesting congenital lobar
emphysema (figure 2-7).
Presence of mass effect of above lesion with compression of
adjacent right lower lobe lung and left side deviation of
mediastinum.
2. Poor demonstration of right upper lobe bronchus, possibly
associated with stenosis/obstruction (figure 5).
Some alveolar densities in medial part of right upper lobe
lung with some atelectasis, may due to infectious/inflammatory
process.
3. A 1.2cm well-defined ovoid lower density lesion without
significant contrast enhancement in right suprahilar region
(figure 2-4), nature to be determined.
Another 0.9cm lower density lesion with mass effect in right
lateral neck (figure 2,3), behind right lobe of thyroid gland with
unknown etiology.
4. No abnormal finding in left lung.
1.5 Tesla MRI of neck and chest with T2 weighted echo train spin echo
with fat saturation, T1 weighted echo train spin echo with fat
saturation, diffusion-weighted echo-planar MR imaging,
T1 weighted Dixon fat-water chemical shift gradient echo,
T2 weighted echo train spin echo with iterative decomposition of
water and fat with echo asymmetry and least-squares estimation,
and with intravenous gadolinium-enhanced images (figure 8-11):
1. A 1.2cm well-defined ovoid long T1 and T2 cystic lesion without
significant restricted water diffusibility or contrast enhancement
in right suprahilar region of mediastinum (figure 8-10), nature to
be determined.
Bronchogenic cyst may be considered firstly.
2. Another 0.9cm lesion with similar MR signals in right
lateral neck, behind right lobe of thyroid gland (figure 8,9,11).
3. History of congenital lobar emphysema.
Presence of relative hyperinflation of right upper and middle
lobe lung with decreased vascular density.
Left side deviation of mediastinum.
Pathology (excision of mediastinal cystic lesion):
A cystic lesion with respiratory lining and lymphoid tissue,
consisted with broncogenic cyst (not showed).
| 
091027 BRONCHOGENIC CYST WITH CONGENITAL LOBAR EMPHYSEMA
