• Manbong Heo, Jong Hwan Jeong, Jung Wan You, Ju-Young Kim, Mi Jung Park, Kyung Nyeo Jeon, Jong Deog Lee, and Seung Jun Lee.
• Department of Internal Medicine.
• Medicine (Baltimore). 2020 May 29; 99 (22): e20246.

RationaleLeft bronchial isomerism is generally associated with abnormal arrangement of the atrium and abdominal viscera; therefore, its diagnosis is confirmed in early childhood.Patient ConcernsHere we report a rare case involving a 36-year-old man with isolated left bronchial isomerism that presented as an asymptomatic severe obstructive ventilatory disturbance during pulmonary function tests performed as part of routine assessments for an orbital wall fracture. The patient was a current smoker and did not show any respiratory symptoms.DiagnosisChest computed tomography revealed left bronchial isomerism, and further tests showed that there was no involvement of other organs.InterventionsWe recommended smoking cessation and the long-term use of an inhaled long-acting bronchodilator.OutcomesThe findings from this case highlight the causative role of left bronchial isomerism in asymptomatic adults with chronic obstructive pulmonary disease.LessonsPhysicians should consider this condition as a cause of obstructive ventilatory disturbances in asymptomatic adult patients.

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