Congenital lobar overinflation

Case contributed by Dr Dylan Kurda

Presentation

A neonate with respiratory distress since birth.

Patient Data

Age: 15 days
Gender: Male

Overinflation of the right middle lobe with herniation to the contralateral left side. Besides, there is partial compression atelectesis of the right upper and lower lobes as well as the left lung. Findings are consistent with congenital lobar overinflation. 

Case Discussion

Congenital lobar overinflation (CLO), previously called congenital lobar emphysema, is a congenital lung abnormality that results in progressive overinflation of one or more lobes of a neonate lung. Various mechanisms have been postulated including an obstructive check valve mechanism at the bronchial level. It usually presents with respiratory distress, mostly during the neonatal period. 

Left upper lobe is most commonly affected (40-45%), followed by right middle lobe (30%)-as in our case, followed by right upper lobe. More than one lobe affection is uncommon (5%). 

Treatment includes follow up in mildly symptomatic patients. However, lobectomy can be considered in severe cases. 

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