Congenital lobar overinflation

Case contributed by Dr Suman Bandhu

Presentation

1-year-old male child presented with respiratory distress. No fever. Previous similar recent episodes reported by parents.

Patient Data

Age: 1 year
Gender: Male

X-Ray Chest

X-ray

Frontal X-ray of chest. There is hyperlucency and increased volume of left hemithorax. Paucity of lung vessels in the hyperlucent lung. Small triangular opacity at left medial lung base. Flattened left hemidiaphragm and mediastinal shift to the right. 

Case Discussion

Congenital lobar overinflation is a congenital abnormality with overinflation of a lobe of lung due to congenital narrowing of the lobar bronchus.

The causes include cartilage abnormality, mucosal fold, mucus plug or extrinsic compression by an abnormal vessel.

This leads to a valve-like condition where air goes into the lobe in inspiration but cannot fully exit during expiration. This causes air trapping, hyperinflation and volume expansion.

The hyper-expanded lobe causes mass effect over the remaining ipsilateral lobe, diaphragm and mediastinum. This is seen as small opacity in the ipsilateral hemithorax, mediastinal shift and flattened hemidiaphragm respectively.

Treatment is observation in mild cases and lobectomy of the abnormal lobe in severe cases.

Association with congenital cardiac disease may be seen in 15%.

CT at tertiary hospital confirmed the diagnosis. Patient was followed up for some time and later had elective surgery due to repeated episodes.

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