Opaque hemithorax with contralateral mediastinal shift


  • A 53 years old man
  • Underlying hypertension
  • Presented with chronic cough and worsening shortness of breath
  • Associated with constitutional symptoms.
Chest radiograph PA erect view

Radiographic findings:

  • There is total opacification of the left hemithorax causing non-visualization of left cardiac border and left hemidiaphragm. No air bronchogram sign within.
  • There is displacement of trachea (yellow arrow) and mediastinum to the right side.
  • There is occlusion of left main bronchus (white arrow).
  • The aerated right lung is clear. No nodule or consolidation seen.
  • No blunting of right costophrenic angle.
  • No obvious bone destruction seen.

Radiological diagnosis: Opaque left hemithorax with mediastinal shift


  • Whitening out of half of the lung field on a chest X-ray is known as opacification of a hemithorax, and its presence usually indicates a significant disease in a patient.
  • Opaque hemithorax with mediastinal shift away from the opacified side can occur when there is increase of volume of affected hemithorax.
  • The differential diagnosis include massive pleural effusion, diaphragmatic hernia, lung mass and diaphragmatic rupture.

Progress of patient:

  • CT scan performed showing huge mass in the left lung total obstruction of left main bronchus causing total collapsed of left lung.
  • Biopsy was performed.
CT thorax in axial plane post contrast, soft tissue and lung windows.

HPE findings:

  • Macroscopy: specimen labelled as lung consists of multiple strips of brownish tissue measuring 2 to 25 mm in length.
  • Microscopy: sections show multiple strips of lung tissue, fibrocollagenous tissue, skeletal muscle and a small bit of skin. The lung tissue and fibrocollagenous tissues are infiltrated by malignant tumour that is arranged as cord and clusters within fibrotic to desmoplastic stroma
  • Immunohistochemical stains: CK7, CK20, TTF-1,p40 are negative. CD55 is positive. Chromogranin, synaptophysin negatives

Interpretation: lung biopsy; poorly differentiated carcinoma.

Author: radhianahassan