Recurrent unilateral lung disease.

A 25-year-old patient, with multiple pulmonary metastases from osteogenic sarcoma who two years ago developed respiratory failure with unilateral left lung involvement and was successfully treated with independent lung ventilation, was readmitted to an ICU with recurrent unilateral lung disease. Conventional therapy failed to reverse the respiratory failure; independent ventilation temporarily improved the patient's oxygenation. At autopsy, different involvement of the two lungs by the tumor was evident so that blood flow of the right lung and lymphatic flow of the left lung were impaired. When respiratory failure unresponsive to conventional therapy develops, anatomical abnormalities should be considered.