respiratory MEDICINE CME CASE REPORT Agenesis of left upper lobe of lung K. Gowrinath a,Ã , K. Manu Mohan a , Chandrakanth M. Shetty b a Department of Tuberculosis and Respiratory Diseases, Kasturba Medical College, Manipal 576104, Karnataka, India b Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal 576104, Karnataka, India Received 23 January 2008; accepted 8 February 2008 KEYWORDS Agenesis of left upper lobe; Lobar agenesis; Congenital malformations of lung; Computed tomography of chest Summary Agenesis of left upper lobe of lung is very rare and may remain undiagnosed for many years. Lobar agenesis is usually asymptomatic but symptoms may occur if the main bronchus is displaced upwards due to volume loss created by lobar agenesis causing improper drainage of respiratory secretions. We report chronic recurrent cough in a 34-year-old male as an unusual presentation of agenesis of left upper lobe. The left upper lobe was not visualized through computed tomography (CT) of chest. Patent foramen ovale and patent ductus arteriosus were also detected as co-incidental cardiac anomalies. Whenever congenital malformations of lung is suspected, CT of chest is recommended before other invasive procedures like pulmonary angiography is considered. & 2008 Elsevier Ltd. All rights reserved. Case report A 34-year-old nonsmoking male was referred for evaluation of abnormal chest radiograph and chronic recurrent cough. He has been suffering from respiratory tract infection lasting for few days once in 3–4 months for the past 15 years. There was no other significant medical history. He was thin built and had digital clubbing. Examination of respiratory system revealed central tracheal position, normal breath sounds and features of volume loss on left side. Cardiovascular system examination showed apical cardiac impulse in the fourth intercostal space lateral to the midclavicular line, loud split second sound and ejection systolic murmur in pulmonary area. Routine blood counts and urinalysis were normal. Sputum examinations were negative for mycobac- teria and bacteria. A chest radiograph (Figure 1) showed reduction of left lung volume with ipsilateral shift of mediastinal contents, blunting of left costophrenic angle, flattened left hemidiaphragmatic shadow and indistinct cardiac borders. Left lateral chest radiograph (Figure 2) revealed retrosternal band like opacity. Ultrasound exam- ination of left hemithorax and abdomen were normal. Flexible bronchoscopy showed purulent secretions within the left main bronchus which was positioned at a wider angle than normal at carina and left upper lobe orifice was not visualized. All bronchoscopic reports were negative. Herniation of contralateral lung, indistinct left upper lobe and absence of major fissure were found through computed tomography of thorax (Figure 3). Total absence of left upper ARTICLE IN PRESS 1755-0017/$ - see front matter & 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.rmedc.2008.02.003 Ã Corresponding author. Tel.: +910820 2922028; fax: +91 0820 2571934. E-mail address: drkgowrinath@gmail.com (K. Gowrinath). Respiratory Medicine CME (2008) 1, 123–125