Diagnosis and management problems in patients with infantile lobar emphysema referred to Shahid Mohammadi hospital, Bandar Abbas, 1994-2004

Introduction: Congenital lobar emphysema (CLE) is rare a rate anomaly of lung
development that usually presents in the neonatal period with respiratory distress
and pulmonary lobar hyper inflation and may present as a diagnostic and
therapeutic dilemma.
Methods: In this descriptive study, we reviewed the clinical features and
management of 6 patients with (CLE) treated in our department over a period of
13 years, from 1990 to 1993.
Blood gas analysis, CX ray, CT of chest and bronchoscopy; if indicated was
done. Lobectomy was performed in 5 patients. All information about the patients,
diagnosis, treatment and 1 year follow up were collected.
Results: Physical examination in all patients showed. Mediastinal shift, decreased
breathing sound in the involved lung and also resonance in percussion. The
involved lobes were: left upper lobe in 3 patients, R middle lobe in 2 patients and
right lower lobe in 1 patient.
In all patients, CX ray showed hyperinflation of the involved lobe and herniation
to the opposite side and atelectasis of the adjacent lobes. In 2 patients with
thachypnea, CT of chest confirmed the diagnosis.
Conclusion: Congenital lobar emphysema should be suspected in any infant
presenting with breathlessness and a simple CX ray is sufficient to establish the
diagnosis in the vast majority of patients. Pneumothorax, tension pneumothorax,
hyperinflation of lung due to foreign body aspiration should be in the list of
differential diagnosis. In patients presented very early in life and those with
severe respiratory symptoms surgery is more indicated.