Congenital lobar emphysema

Case contributed by Dr Ahmed Subaie

Presentation

Respiratory distress

Patient Data

Age: 6 months
Gender: Male
X-ray

Initial frontal radiograph at birth demonstrate a hazy opacity occupying left upper lobe with mass effect and shifting of mediastinal structures to the right side.

Focal lucency and overinflation of the left upper lobe with mediasinal shift to the right.

CT

There is left upper lobe lucency, attenuated vascularity and overinflation.

Case Discussion

Congenital lobar emphysema is pathologic overdistension  of a lobe. there is no true emphysema pathologically that's why many call this abnormality " Congenital lobar overinflation".

In half of the cases, there is no demonstrable cause.

On radiography or CT, there is lobar hyperlucency, attenuated vascularity, mediastinal shift and may be compression of the contralateral lung.

Treatment is by surgical lobectomy. If symptoms are mild, one might consider conservative management.

All should undergo CT scan to exclude extrinsic bronchial compression.

In the appropriate age group, you might consider bronchoscopy to exclude foreign body as a cause of overinflation. Left upper lobe foreign body aspiration is uncommon.

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Case information

rID: 24682
Case created: 4th Sep 2013
Last edited: 29th Feb 2016
Systems: Paediatrics, Chest
Inclusion in quiz mode: Included

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