Unilateral Pulmonary Agenesis Presenting in the Eighth Decade: A Case of Lifelong Clinical Silence

Abstract Pulmonary agenesis is a rare congenital anomaly defined as the complete absence of lung parenchyma, bronchus, and pulmonary vasculature. The incidence is approximately 1.22 per 100,000 live births. We report the case of a 76-year-old woman who presented with progressive exertional dyspnea for 12 years, worsening over 3 days, and intermittent chest pain. Examination revealed absent air entry and dullness over the left hemithorax, tracheal shift to the left, and rib crowding. Chest radiograph showed left hemithoracic opacity with mediastinal shift. Computed tomography pulmonary angiography revealed a complete absence of the left lung, main bronchus, and pulmonary vasculature, ipsilateral mediastinal shift, double superior vena cava, and pulmonary hypertension. The patient was treated conservatively. She improved clinically and was discharged with home oxygen. This case emphasizes the importance of considering pulmonary agenesis, in the differential diagnosis of unilateral hemithoracic opacity, even in elderly patients, and highlights the role of imaging in establishing the diagnosis.