Rare case of horseshoe lung associated with scimitar syndrome in Palestine: a case report

The caudal and basal parts of the lungs are fused together in a rare congenital bronchopulmonary anomaly known as horseshoe lung. The majority of horseshoe lung cases are associated with scimitar syndrome. Most patients present with nonspecific symptoms. Multidetector pneumoangiography can be used to diagnose horseshoe lung, which shows that the isthmus of the pulmonary parenchyma traverses the midline, connecting the two lungs together. Treatment and prognosis are usually determined depending on the presence of other concomitant anomalies and the degree of symptom severity.

A 3-month-old-male patient presented with respiratory symptoms and a history of chest infection. Chest imaging revealed anomalous venous drainage from the right lower lobe of the lung, right lung hypoplasia with mediastinal shift, and a parenchymal isthmus extending between the two lungs. The patient was diagnosed with horseshoe lungs associated with scimitar syndrome. He was also found to have extralobar sequestration to the right lower lobe of the lung. The patient underwent surgical management in the form of tunneling of the anomalous vein into the left atrium using pericardium autograft ligation of the sequestration artery.

Because of its common association with other congenital malformations such as scimitar syndrome and cardiovascular defects, clinicians should be meticulous in the investigation and workup process of patients with horseshoe lung in order not to miss any of these associated abnormalities.

Although it is very rare, horseshoe lung should be considered in the differential diagnosis of respiratory distress symptoms, especially in children younger than 1 year.