Lung Cyst (Differential Diagnosis Diaphragmatic Hernia/RDS)

atno_14a_n.jpg: Chest x-ray of a 2.5-week-old newborn with respiratory distress syndrome. A rounded zone of missing lung structures is visible in the right middle and lower hemithorax. The right auricle of the heart is missing, too. The findings correspond to the diagnosis of a cyst of the right lower lobe. Due to a mediastinal shift the right border of the heart shadow is not visible. The right middle and upper lobe is compressed and displaced upwards and to the medial side. atno_14b_n.jpg: Postoperatively, 1.6 years later a normal lung structure and heart shadow is recognizable on both sides. The right hemithorax is now completely occupied by the almost complete lung; therefore, not a smaller hemithorax results as in atno_12_n.jpg, but in comparison to the left side, a normal hemithorax. Due to the thoracotomy a slight dent on the right lateral chest wall is visible. atno_14c_n.jpg: Operative findings in the same patient; the multilocular cyst of the lung protrudes between the visible upper lobe (on the right side in the picture) and the basal lower lobe segments (on the left side in the picture). atno_14d_n.jpg: The lung cyst has a small base and extends from the bronchial system of the lower right lobe. On the left and bottom of the picture there is the right lower lobe, on the right and top there is the right middle lobe, followed by the upper lobe. Generally, the cystic malformations of the lung (mainly localized in the lower lobe) and mainly the adenomatoid-cystic variety become clinically apparent earlier and more distinctly than the lobar emphysema (mainly localized in the upper lobe).