Completely opaque hemithorax

A 45‐year‐old male patient, normotensive, non‐diabetic, married with children, auto parts dealer by profession, presented to us with complaints of cough with expectoration, low grade fever and breathlessness from past 15 days. He gave no history of previous diseases or surgical intervention. General examination was unremarkable. On respiratory system examination, the left sided shoulder was drooping; trachea deviated to left and apex beat palpable in fifth intercostal space at left mid axillary line. On percussion, impaired to dull note was observed all over the left side. On auscultation, breath sound were absent in the left axillary and infra axillary areas; decreased intensity breath sounds could be heard in the left inter scapular and infra scapular areas. Occasional crepitations were heard over the right hemithorax. CVS (Cardio‐vascular system), CNS (Central nervous system) and per‐abdominal examinations revealed no abnormality. TLC (Total leukocyte count) was 12,400/mm3, kidney and liver function tests were normal and the Mantoux test was negative. Chest radiograph (PA view) demonstrated opaque left hemithorax with volume loss, ipsilateral mediastinal shift, right sided compensatory hyperinflation and scoliosis of dorsal spine with concavity to the left side [Figure 1]. USG of abdomen was normal. Contrast enhanced CT scans of chest lung window [Figure 2].