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Year : 2019  |  Volume : 36  |  Issue : 2  |  Page : 162-163  

Radiolucent right paratracheal mass: Incidental detection of an uncommon entity

1 Research Associate, Radio Diagnosis, PGIMER, Chandigarh, India
2 Department of Radio Diagnosis, Radio Diagnosis, PGIMER, Chandigarh, India
3 Assistant Professor, Radio Diagnosis, PGIMER, Chandigarh, India
4 Professor and Head, Radio Diagnosis, PGIMER, Chandigarh, India

Date of Web Publication28-Feb-2019

Correspondence Address:
Dr. Uma Debi
Assistant Professor, Department of Radio Diagnosis, PGIMER, Chandigarh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/lungindia.lungindia_452_18

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How to cite this article:
Singh L, Debi U, Bhatia V, Sandhu MS. Radiolucent right paratracheal mass: Incidental detection of an uncommon entity. Lung India 2019;36:162-3

How to cite this URL:
Singh L, Debi U, Bhatia V, Sandhu MS. Radiolucent right paratracheal mass: Incidental detection of an uncommon entity. Lung India [serial online] 2019 [cited 2020 May 25];36:162-3. Available from: http://www.lungindia.com/text.asp?2019/36/2/162/253194

   Case History Top

A 64-year-old female patient with low abdominal pain and ultrasound revealing bilateral cystic adnexal masses underwent contrast-enhanced computed tomography (CECT) chest and abdomen for the characterization of pelvic masses and screening for any metastasis. CECT abdomen revealed bilateral enlarged cystic masses in adnexal region suggestive of ovarian origin (not shown). Rest of the abdomen was normal. Her chest scanogram revealed a radiolucent right paratracheal lesion causing mild indentation over the trachea [Figure 1]. CECT chest-lung window showed the evidence of apical lucency on the right side [Figure 2]. No definite communication with the trachea or esophagus was seen. No air-fluid level was seen.
Figure 1: Chest scanogram shows lucent area in the right paratracheal region (red arrow) causing mild indentation over the trachea

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Figure 2: Contrast-enhanced computed tomography chest axial (a) and coronal (b) lung window images showing apical lung herniation (blue arrows)

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   Question Top

What is the diagnosis?

   Answer Top

Apical lung herniation.

   Discussion Top

Apical lung herniation is a relatively uncommon cause of radiolucent paratracheal mass which may cause tracheal deviation. These are usually asymptomatic and incidentally detected on radiological investigations.

Lung herniation is divided into apical (cervical), intercoastal (thoracic), and diaphragmatic varieties in the literature.[1],[2] Each of these could be either congenital (20%) or acquired (80%).

Apical hernias in the pediatric population are usually congenital with spontaneous resolution, whereas in adults they are usually acquired. Around one-third of apical hernias in adults are spontaneous and seen in patients with chronic cough or those in certain professions such as weightlifters and wind instrumentalists.[2],[3]

Apical lung herniation is a rare variety which develops through a defect in the Sibson's fascia (cervicothoracic fascia) also called as suprapleural membrane which attaches to the inner border of the first rib to the transverse process of the seventh cervical vertebra. Furthermore, small defects have been found in the apical parietal pleura in addition to suprapleural membrane which develops into larger defects.[1],[2],[4]

Most of these patients are asymptomatic; however, few cases of tracheal irritation or dysphagia have been described in the literature.[4]

Most of these patients are asymptomatic and managed conservatively, however, detection is important to avoid complications such as pneumothorax during procedures such as central line placement. Surgical intervention with repair of the fascia is only indicated for symptomatic patients or those with cosmetic deformity.[4]

On chest radiographs, these are seen as apical radiolucency that may cause lateral deviation of the trachea. Computed tomography scan is the investigation of the choice for the diagnosis and to rule out other potential mimickers on chest radiographs such as pharyngoceles, laryngoceles, and esophageal diverticula by showing contiguity to these structures or air-fluid level.[2],[4]

Apical hernia, although a benign asymptomatic entity, is important to be detected to avoid inadvertent iatrogenic complications such as pneumothorax and to differentiate from other mimickers on chest radiographs in symptomatic patients.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Prasad S, Rao K, Belle J, Rau NR. An unusual cause for neck swelling: Apical lung hernia. BMJ Case Rep 2014;2014. pii: bcr2013202952.  Back to cited text no. 1
Bhalla M, Leitman BS, Forcade C, Stern E, Naidich DP, McCauley DI, et al. Lung hernia: Radiographic features. AJR Am J Roentgenol 1990;154:51-3.  Back to cited text no. 2
Ranu H, Jackson M. Apical lung herniation. Thora×2011;66:740.  Back to cited text no. 3
McAdams HP, Gordon DS, White CS. Apical lung hernia: Radiologic findings in six cases. AJR Am J Roentgenol 1996;167:927-30.  Back to cited text no. 4


  [Figure 1], [Figure 2]


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