Unilateral diffuse lung opacification in an asymptomatic woman

A healthy woman aged 19 years was sent to the general hospital in Malaysia by her family physician for a routine medical check-up, as this was a prerequisite for admission to a university graduate course. She was asymptomatic. She did not complain of cough, breathlessness, fever, night sweats, loss of appetite or loss of weight. On examination, vital signs were normal. Her height was 157 cm and she weighed 54 kg. On local examination of the chest, her trachea was shifted significantly to the left side, and the left hemithorax moved less on inspiration, compared with the right. The apex beat was felt in the fifth left intercostal space at the anterior axillary line. Percussion note was dull over the left hemithorax, and auscultation revealed diminished air entry over the entire left chest, anteriorly and posteriorly, with diminished vocal resonance over the same area. The right side was normal. No surgical scars were seen over the chest wall and there was no past history of surgery. The rest of the clinical examination was normal. A chest radiograph (posterioranterior view) showed a diffuse opacity over the entire left hemithorax with the trachea shifted to the left side.