Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Posterior Lung Herniation in Pulmonary Agenesis and Aplasia: Chest Radiograph and Cross-Sectional Imaging Correlation

  • Ji Young Kim (Department of Radiology, Seoul National University College of Medicine) ;
  • Woo Sun Kim (Department of Radiology, Seoul National University College of Medicine) ;
  • Kyung Soo Lee (Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine (SKKU-SOM)) ;
  • Bo-Kyung Je (Department of Radiology, Korea University College of Medicine, Ansan Hospital) ;
  • Ji Eun Park (Department of Radiology, Ajou University Medical Center) ;
  • Young Jin Ryu (Department of Radiology, Seoul National University College of Medicine) ;
  • Young Hun Choi (Department of Radiology, Seoul National University College of Medicine) ;
  • Jung-Eun Cheon (Department of Radiology, Seoul National University College of Medicine)
  • Received : 2021.02.22
  • Accepted : 2021.06.01
  • Published : 2021.10.01
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Abstract

Objective: To describe the anatomic locations and imaging features of posterior lung herniation in unilateral pulmonary agenesis and aplasia, focusing on radiograph-CT/MRI correlation. Materials and Methods: A total of 10 patients (seven with pulmonary agenesis and three with pulmonary aplasia, male: female = 1:9, mean age 7.3 years, age range from 1 month to 20 years) were included. Chest radiographs (n = 9), CT (n = 9), and MRI (n = 1) were reviewed to assess the type of lung underdevelopment, presence of anterior and posterior lung herniation, bronchus origin, supplying artery, and draining vein of the herniated lung. Results: Pulmonary agenesis/aplasia more commonly affected the left lung (n = 7) than the right lung (n = 3). Anterior lung herniation was observed in nine of the 10 patients. Posterior lung herniation was observed in seven patients with left pulmonary agenesis/aplasia. Two patients showed posterior lung herniation crossing the midline but not beyond the aorta, and five patients showed the posteriorly herniated right lower lobe crossing the midline to extend into the left hemithorax farther beyond the descending thoracic aorta through the space between the esophagus and the aorta. This anatomical configuration resulted in a characteristic radiographic finding of a radiolucent area with a convex lateral border and a vertical medial border in the left lower lung zone, revealing a tongue-like projection on CT and MRI. Conclusion: Posterior lung herniation occurs in unilateral left lung agenesis/aplasia. Approximately 70% of the cases of posterior lung herniation reveal a unique radiolucent tongue-like projection in the left lower lung zone on imaging studies, which is caused by the extension of the posteriorly herniated right lung farther beyond the descending aorta.

Keywords

Acknowledgement

This study has received funding by grant no. 02-2013-063 from the Seoul National University Bundang Hospital research fund.

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