Near Complete Obliteration of the Left Hemithorax by Congenital Lobar Emphysema in an Adult

Fatal congenital lobar emphysema in a puerpera: a case report and literature review

Background

Congenital lobal emphysema (CLE) is a developmental lung abnormality usually diagnosed in the neonatal period and is rarely observed in adults. Adults with CLE are usually asymptomatic and only a small fraction may present with coughing, recurrent pneumonia and respiratory distress. In imaging studies, the most frequently affected lobe of CLE is the left upper lobe, followed by the right middle lobe. However, multilobar involvement with severe mediastinal shift is extremely rare.

Case presentation

We report a case of fatal CLE in a 28-year-old puerpera with postpartum respiratory failure. Chest computed tomography (CT) revealed emphysema of the right upper, middle and lower lobes resulting in adjacent atelectasis. Hyperinflation of the right upper lobe crossed the midline, leading to a deviation of the mediastinal structure to the left hemithorax and severe compression of the left lung.

Conclusions

Early and timely diagnosis of CLE with routine follow-up is necessary for patients. CLE, especially with multilobar involvement or mediastinal shift, could be life-threatening and should be promptly and aggressively treated to prevent severe complications.

An unusual case of unilateral hyperlucent lung

A 38-year-old male, clerk by profession, presented to our institute with complaints of cough without expectoration and difficulty in breathing for 3 years. The dyspnoea was persistent, exertional and had progressively worsened over this period of 3 years, it was currently grade 2 on the modified Medical Research Council (mMRC) grading. He was a never-smoker and there was no history of environmental tobacco smoke or exposure to noxious particles or history of illicit drug abuse. Past medical and surgical history was not significant. There was no history of significant respiratory infections during childhood and there was no history of anyone in his family with similar complaints.

Differential diagnoses of unilateral hyperlucent lung are expansive, ranging from soft tissue to pulmonary parenchyma. A systematic approach to interpretation of radiography guides us in quick localisation of the anatomical site of involvement.https://bit.ly/3fNy4vT

Management of congenital lobar overinflation in an adult

Congenital lobar overinflation is characterized by disruption of bronchopulmonary development which produces lobar or segmental bronchial abnormalities and overinflation of normal lung tissue. This is a 44-year old man, never smoker, who presents dyspnea every time he arrived in highlands, marked decreased breathing sounds and hyperresonance in the left hemithorax. Imaging studies suggested left upper lobe overinflation. The affected area was resected resulting in symptoms improvement. Accepted treatment is resection, however conservative management has been proposed for asymptomatic patients because cases of spontaneous improvement have been described. We recommend close monitoring and resection if symptoms or overinflation progress.

Congenital lobar emphysema: diagnosis and treatment options

Although congenital lobar emphysema is a rare lung disease, it can cause severe respiratory distress in the newborn. Lobectomy can be difficult because of the hyperinflated lobe and limited space to carry out surgery. During the past two decades, conservative treatment options have increased for patients with mild and moderate disease.