1
|
Abera MT, Abdela AF, Hailu SS. Rare presentation of a rare disease: Bilateral congenital lobar overinflation. Radiol Case Rep 2024; 19:1496-1502. [PMID: 38283738 PMCID: PMC10810743 DOI: 10.1016/j.radcr.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/03/2024] [Indexed: 01/30/2024] Open
Abstract
Congenital lobar overinflation is a rare but well-recognized congenital cause of neonatal and infantile respiratory distress. At times, the condition can mimic other congenital or acquired diseases and have atypical distribution and imaging patterns. Lobectomy of the involved lobe(s) is curative. We present our experience with 3 surgically confirmed cases of congenital lobar overinflation. Referral papers, patient's charts, including operation notes, and radiographic records were reviewed. All of them were initially misdiagnosed or underdiagnosed based on the initial radiographic examination alone. All 3 were referred to our center with respiratory distress, and the first 2 were treated with antibiotics prior to the settlement of their diagnosis. Chest computed tomography was key in diagnosing all 3 cases. The first patient was a 10-day-old neonate diagnosed with bilateral congenital lobar overinflation. The second patient was a 2-month-old infant diagnosed with right middle lobe disease. In these 2 cases, the initial assessment of the vascularity was atypically excessive in the affected lobe(s). Eventually, correlation with typical concurrent imaging features and the clinical condition of the patients led to the correct diagnosis. The third case was a 4-month-old infant with left upper lobe congenital lobar overinflation. All cases underwent successful surgical treatment. Congenital lobar overinflation is a rare anomaly, and multiple-lobe involvement is even rarer. Vascularity within the affected lobes is a subjective assessment that can be overestimated, leading to confusion, and a feature that needs correlation with other common imaging features and the clinical course of patients.
Collapse
Affiliation(s)
| | - Abubeker Fedlu Abdela
- Department of Radiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Samuel Sisay Hailu
- Department of Radiology, Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| |
Collapse
|
2
|
Choudhury S, Dubey S, Kumar R. Congenital Lobar Emphysema Presenting as Respiratory Distress in a Newborn. Cureus 2023; 15:e40545. [PMID: 37465796 PMCID: PMC10350634 DOI: 10.7759/cureus.40545] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2023] [Indexed: 07/20/2023] Open
Abstract
Congenital lobar emphysema (CLE) is a rare developmental malformation that presents as neonatal respiratory distress and can be successfully managed with prompt intervention. Hyperinflation of the affected lobe with mediastinal shift is the characteristic radiological finding. However, the etiology mostly remains unknown. Here, we report a case of CLE that microscopically revealed bronchial cartilaginous hypoplasia as an underlying cause of this malformation.
Collapse
Affiliation(s)
- Sampa Choudhury
- Pathology, Andaman and Nicobar Islands Institute of Medical Sciences (ANIIMS), Port Blair, IND
| | - Suparna Dubey
- Pathology, Andaman and Nicobar Islands Institute of Medical Sciences (ANIIMS), Port Blair, IND
| | - Ritesh Kumar
- Surgery, Andaman and Nicobar Islands Institute of Medical Sciences (ANIIMS), Port Blair, IND
| |
Collapse
|
3
|
Gatt D, Lapidus-Krol E, Chiu PPL. The long-term outcomes of symptomatic congenital lobar emphysema patients. Pediatr Pulmonol 2023; 58:1520-1526. [PMID: 36825306 DOI: 10.1002/ppul.26354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/25/2023]
Abstract
INTRODUCTION Surgical (OP) management for symptomatic congenital lobar emphysema (CLE) is the standard of care with nonoperative (NOP) approach applied for asymptomatic cases. The aim of this study is to report the outcomes for NOP approach to the care of symptomatic CLE infants. METHODS A retrospective study of CLE patients treated 2000-2021 at a single institution. Patients with CLE and respiratory symptoms were included. RESULTS Overall, 23 children had symptomatic CLE, and 12 had NOP management. The median age at diagnosis was 38.5 days (50) in the NOP group versus 25 days (20) in the OP group (p = 0.31). There was no significant difference in the location of the involved lobe, term birth, postnatal diagnosis and gender, and both groups required noninvasive support in 33% of the cases. There was a trend towards higher frequency of oxygen support in the OP group preoperatively (89% vs. 42%, p = 0.07). The median length of stay was 14 days in the NOP group compared to a median postsurgery stay of 7.5 days in the OP group. In follow-up, there was no significant difference in respiratory readmission in first year of life, growth delay, treatment with asthma medication or body mass index in the NOP versus OP group. None of the children in the NOP group required surgery during follow-up. CONCLUSIONS A NOP approach for symptomatic CLE infants can have favorable long-term outcomes. Further studies will be required to identify markers to aid in clinical decision-making.
Collapse
Affiliation(s)
- Dvir Gatt
- Department of Pediatrics, Division of Respiratory Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eveline Lapidus-Krol
- Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Priscilla P L Chiu
- Department of Surgery, Division of General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Ohm B, Jungraithmayr W. Angeborene Fehlbildungen der Lunge – eine Übersicht. Zentralbl Chir 2022; 147:90-97. [DOI: 10.1055/a-1669-9574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
ZusammenfassungKongenitale pulmonale Malformationen stellen eine heterogene Gruppe seltener
Erkrankungen dar, die auf Fehlentwicklungen während der embryonalen und fetalen
Wachstumsphase basieren. Zu ihnen gehören der Trachealbronchus, die bronchiale
Atresie, die bronchogene Zyste, die Lungensequestration, das kongenitale lobäre
Emphysem sowie die sogenannte Congenital pulmonary Airway Malformation. Eines
der Leitsymptome dieser Malformationen ist die durch ihren verdrängenden Effekt
bedingte postnatale respiratorische Insuffizienz, welche eine rasche operative
Versorgung erfordert. Auch bei asymptomatischen Malformationen wird aufgrund des
erhöhten Infektrisikos die Resektion empfohlen.In der folgenden Übersicht wird auf die Ursachen, das klinische Bild und die
therapeutischen Optionen dieser angeborenen Fehlbildungen der Lunge und des
Bronchialsystems eingegangen.
Collapse
Affiliation(s)
- Birte Ohm
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische
Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg,
Deutschland
| | - Wolfgang Jungraithmayr
- Klinik für Thoraxchirurgie, Universitätsklinikum Freiburg, Medizinische
Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg,
Deutschland
| |
Collapse
|
5
|
Asnake ZT, Salabei JK, Pierce J, Fernandez A, Ahmad R, Ismail ZH, Mathew C. An atypical case of congenital lobar emphysema in an adult, non-smoker patient presenting with pneumothorax. Respir Med Case Rep 2021; 34:101435. [PMID: 34367905 PMCID: PMC8326181 DOI: 10.1016/j.rmcr.2021.101435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/17/2021] [Accepted: 05/27/2021] [Indexed: 11/27/2022] Open
Abstract
Congenital lobar emphysema (CLE) is a developmental anomaly of the lower respiratory tract characterized by hyperinflation of one or more pulmonary lobes in the absence of extrinsic bronchial obstruction. We present a case of a 24-year-old male, nonsmoker who presented with shortness of breath and severe left sided chest pain. A chest x-ray was significant for a very large left-sided pneumothorax and chest CT showed lobar emphysematous changes. Video assisted thoracoscopic surgery (VATS) and lobectomy was subsequently performed after persistence of pneumothorax despite chest tube insertion and conservative management. Surgical pathology of resected specimen showed chronic emphysematous changes with patchy chronic organizing pneumonitis. Histology showed advanced emphysematous changes of pulmonary parenchyma consistent with congenital lobar emphysema. This finding combined with features seen on computed tomography of the chest led to the diagnosis of congenital lobar emphysema. This case demonstrated that CLE can be a cause of tension pneumothorax in adults in rare cases.
Collapse
Affiliation(s)
- Zekarias T Asnake
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Joshua K Salabei
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Jordan Pierce
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Angela Fernandez
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Ramin Ahmad
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Zeeshan H Ismail
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| | - Calestino Mathew
- University of Central Florida College of Medicine, Graduate Medical Education, North Florida Regional Medical Center, Internal Medicine Residency Program, 6500 W Newberry Rd, Gainesville, FL, 32605, USA
| |
Collapse
|
6
|
Xie J, Wu Y, Wu C. Is thoracoscopy superior to thoracotomy in the treatment of congenital lung malformations? An updated meta-analysis. Ther Adv Respir Dis 2020; 14:1753466620980267. [PMID: 33308023 PMCID: PMC7739138 DOI: 10.1177/1753466620980267] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background: A meta-analysis was performed for a comparison of outcomes between video-assisted thoracoscopic surgery (VATS) and thoracotomy for congenital lung malformations (CLM). Methods: Electronic databases, including PubMed, Scopus, Embase, and the Cochrane Library were searched systematically for literature aimed mainly at reporting the therapeutic effects for CLM administrated by VATS and thoracotomy. Results: A total of 40 studies meeting the inclusion criteria were included, involving 2896 subjects. VATS was associated with fewer complications [odds ratio (OR) 0.54; 95% confidence interval (CI), 0.42–0.69], less use of epidural anesthesia (OR, 0.08; 95% CI, 0.03–0.23), shorter length of hospital stay [standard mean difference (SMD) −0.98; 95% CI, −1.4 to −0.55] and chest drainage (SMD, −0.43; 95% CI, −0.7 to −0.17), as compared with thoracotomy. However, thoracotomy showed superiority in reduced operative time (SMD, 0.44; 95% CI, 0.04–0.84). Pearson analysis (Pearson r = 0.85, 95% CI, 0.28 to 0.98, p = 0.01) and linear regression (R square 0.73) confirmed a positive correlation between percentage of symptomatic cases and conversion in patients using VATS. Conclusion: VATS is associated with fewer complications, less use of epidural anesthesia, shorter length of stay and length of chest drainage, but longer operative time, as compared with thoracotomy. Symptomatic patients with CLM using VATS may be prone to conversion to thoracotomy. The reviews of this paper are available via the supplemental material section.
Collapse
|
7
|
Shen C, Che G. Congenital Lobar Emphysema in an Elderly Patient. Am J Respir Crit Care Med 2020; 202:1579-1580. [PMID: 32897729 DOI: 10.1164/rccm.202004-1337im] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Cheng Shen
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| | - Guowei Che
- Department of Thoracic Surgery, West-China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
8
|
Abdel-Bary M, Abdel-Naser M, Okasha A, Zaki M, Abdel-Baseer K. Clinical and surgical aspects of congenital lobar over-inflation: a single center retrospective study. J Cardiothorac Surg 2020; 15:102. [PMID: 32429981 PMCID: PMC7236189 DOI: 10.1186/s13019-020-01145-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 05/04/2020] [Indexed: 12/04/2022] Open
Abstract
Background Congenital lobar overinflation (CLOI) is one of the most important causes of infantile respiratory distress (RD). We aim to evaluate our experience in CLOI management emphasizing on clinical features, diagnostic modalities, surgery and outcomes. Methods This is a retrospective study for all CLOI cases undergoing surgical management at Qena University Hospital. Demographic data, clinical data, radiographic findings, surgery and postoperative follow-up were reviewed. Results A total of 37 neonates and infants with CLOI were presented to our center between January 2015 and January 2019; their mean age was 111.43 ± 65.19 days and 22 were males. All cases presented with RD; and cyanosis in 19 cases. 15 cases presented with recurrent pneumonia and fever. Diminished breath sounds on the affected side and wheezes were the main clinical findings in 30 and 22 cases respectively. On CXR, emphysema was detected in all cases. A confirmatory CT chest was done for all cases. Left upper lobe was affected in 23 cases, right middle lobe in 7 and right upper lobe in 7 cases. Lobectomy was done in thirty-one cases; their mean age at surgery was 147.58 ± 81.49 days and 19 were males. Postoperative complications were noted in 5 cases and postoperative ventilation was required for 2 of them. No morbidity or mortality was reported. The follow-up duration ranged from 3 months to 1 year and all patients were doing well except one case that lost follow up after 3 months. Conclusion CLOI is a rare bronchopulmonary malformation that requires a high index of clinical suspicion, especially in persistent and recurrent infantile RD. CT chest is the most useful diagnostic modality. Early management of CLOI improves outcome and avoid life-threatening complications. Surgical management is the treatment of choice in our center without recorded mortality.
Collapse
Affiliation(s)
- Mohamed Abdel-Bary
- Department of Cardiothoracic Surgery, Qena Faculty of Medicine, South Valley University, Safaga Road, Qena, 83523, Egypt.
| | - Mohamed Abdel-Naser
- Department of Anaesthesia and ICU, Assiut Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed Okasha
- Department of Radiology, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| | - Mohammed Zaki
- Department of Radiology, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Khaled Abdel-Baseer
- Department of Pediatrics, Qena Faculty of Medicine, South Valley University, Qena, Egypt
| |
Collapse
|