Presentation
Severe pain in the left chest.
Patient Data
There is evidence for right sided volume loss with a shift of the mediastinum to the right. There is no evidence for active pulmonary disease.
There is hypoplasia of the right lung, manifested by decrease in volume of the right lung, decreased in caliber of the bronchial tree, and decrease in caliber of the pulmonary arterial circulation. There is no evidence of bronchiectasis or old inflammatory disease. A pinpoint calcified granuloma is present in right lung. The pulmonary veins drain normally into the left atrium, with no evidence of anomalous pulmonary venous return. There is decrease in diameter of the right pulmonary artery compared to the left pulmonary artery.
There is absence of the right superior vena cava. The left superior vena cava drains via the coronary sinus into the right atrium.
Case Discussion
This 55 year old man presented to the ED with complaints of new onset left sided chest pain. A chest x-ray was performed and demonstrated unexplained right sided volume loss, and a chest CT was recommended. Incidental findings of right lung hypoplasia and left sided superior vena cava were identified. There was no anomalous pulmonary venous return to suggest scimitar syndrome. The patient's cardiac enzymes and EKG were normal. There was no imaging explanation for his chest pain.
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