A 50-year-old, nonsmoker woman was admitted to outpatient clinic for periodic examination. She was diagnosed with lung tuberculosis at the age of six and had history of several times of hospitalisation with the diagnosis of recurrent pulmonary infections. She had two term healthy deliveries. She had no complaints.
At the physical examination, slight ipsilateral deviation of the trachea was found. There were fine crackles and decreased breath sounds on the left side. Findings on the rest of the physical examination were unremarkable. Routine hematologic and biochemical profiles were within the normal ranges.
Plain radiograph showed a loss of volume of her left lung, cardiac and mediastinal displacement to the left, increased density in the left lower lung zone, and hyperinflation of the lung on the right side (Figure 1). Hemidiaphragm elevation with volume loss of the left lung and absence of hilar shadow were remarkable.
Echocardiogram showed no apparent structural abnormality of the heart, and no pulmonary hypertension (pressure gradient = 20 mmHg) was detected. Pulmonary function tests showed a ratio of forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) of 80%; FEV1 of 2.47 L (61% of predicted), FVC of 2.90 L (52% of predicted), total lung capacity of 67% of predicted, and a diffusion capacity for carbon monoxide of 72% of predicted.
Contrast-enhanced 7 mm collimator computed tomographic (CT) of the chest showed an enlargement of the pulmonary artery trunk and demonstrated the absence of the left pulmonary artery with displacement of heart and mediastinum to the left and volume loss associated with increased interstitial markings involving her left lung (Figures 2(a) and 2(b)). Cardiac arteriographic study revealed no other additional cardiac abnormalities.
We decided to follow up the patient for respiratory symptoms, such as breathlessness, hemoptysis, and pulmonary hypertension. The risk factors regarding the absence of a pulmonary artery and travelling to high altitude were explained to our patient. Her clinical status remained stable, without any symptoms, during the follow-up period.