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The volume loss created by the absence of the LUL and LLL hypoplasia might also have resulted in displacement of the rudimentary left main bronchus upwards at the carina causing impaired bronchopulmonary drainage and led to recurrent left-sided infections. We do not have any history of infections having occurred between the original catheterization at 6 weeks of life and that from April 2009. The antamonic differences between unilateral lung aplasia and agenesis may produce significant differences in the pathogenesis of respiratory distress and thus in clinical course and prognosis. Multiple factors play a role, including presence of a blind bronchial rudiment, increase in "dead space," mediastinal shift, tracheal compression, venous kinking, and emphysema of the single lung. The fact that the left lung is affected with a left-sided aortic arch is in this patient's favor, since mediastinal shift has occurred to the left, avoiding more severe vascular tracheal compression that would have occurred if the hypoplasia had been of the right lung.
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