成人單側性肺臟發育不全

UNILATERAL PULMONARY HYPOPLASIA IN ADULT

李仁杰(Reng-Jye Lee)

《中華放射線醫學雜誌》 2卷4期 (1977/12) Pp. 351-356

摘要

單側性肺發育不全是肺發育異常之一、在成人的病例，並不多見，病人常無症狀，所以患者未必就醫。本症往往在例行胸部X光檢查時偶被發現，在接受進一步的支氣管及血管造影檢查時，其特殊的發現，大多可確立診斷。本文介紹兩病例，皆20歲左右，一般發育良好，在一般胸部X光造影時，發現皆有顯著的氣管與縱膈器官移向左側，左側肋間距離輕微縮小，右側肺過度充氣，並向左疝逸，左膈膜上昇，顯示左肺無氣影像，支氣管造影檢查，發現左側主支氣管約等於正常口徑，然而分枝及肺泡組織顯著減少或縮小。其中第二病例還伴有支氣管擴張症。肺動脈血管造影亦顯示心臟左移，左肺動脈口徑減小，分枝減少。此症須與結核、腫瘤、支氣管異物等引起的肺不張作鑑別診斷。

並列摘要

Hypoplasia of one lung is a rare congenital anomaly, especially in adult case. It is usually asymptomatic. The disease is always discovered at routine chest roentgenogram, and may be a surprise finding at autopsy. Two cases were presented in this article. Both of them were about twenty years old and were good in development. The roentgenographic findings were rather characteristic. On the plain chest roentgenogram, marked shift of the mediastinum and trachea to the left side, very minimal narrowing of the intercostal spaces and herniation of the right lung across the mediastinum were recognized. On the bronchograms, the entire bronchial tree shifted to left side, there was no filling of small bronchi and alveoli in the first case. Decreased branching of the bronchi and bronchiectatic change were noted in the second case. Pulmonary arterio-angiography revealed rotation of heart to the left side. There was marked decreased in caliber of the main trunk of left pulmonary artery. No branching of the left pulmonary artery was noted in the first case, for the second case, small and lesser branches from the left pulmonary artery were demonstrated. The differential diagnosis should include advanced bronchiectasis, fibrothorax due to tuberculosis, bronchogenic carcinoma and intrabronchial foreign body.