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Ann Thorac Surg 2008;85:665. doi:10.1016/j.athoracsur.2007.06.021
© 2008 The Society of Thoracic Surgeons
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Images in Cardiothoracic Surgery

Congenital Lobar Emphysema

Sylvia Glüer, MD*, Marc Reismann, MD, Benno M. Ure, MD

Department of Pediatric Surgery, Hannover Medical School, Hannover, Germany

* Address correspondence to Dr Glüer, Medical School Hannover, Pediatric Surgery, Carl-Neuberg Str. 1, Hannover, D-30623, Germany (Email: glueer.sylvia{at}mh-hannover.de).

A 7-week-old boy (with an uneventful medical history to date) was admitted with moderate dyspnea, tachypnea, and mild peripheral cyanosis. Breathing sounds were reduced on the left side and heart beats shifted to the right side. The results of blood gases, complete blood counts, and serum biochemistry profiles were within normal limits. A chest roentgenogram revealed emphysema of the left upper lobe with herniation across the midline leading to the mediastinal shift, and compression of the remaining left and right pulmonary lobes (Fig 1). Resection of the emphysematous lobe was done by video-assisted thoracic surgery using 3.5-mm instruments and Ligasure (Valleylab, Boulder, CO). His postoperative course was complicated by left-sided chylothorax that spontaneously resolved. Eight months after the resection the boy is doing well with almost no visible scars.


Figure 1
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  		Fig 1.
 
Congenital lobar emphysema was present with the overexpansion of a pulmonary lobe and resultant compression of the remaining lung and mediastinal structures. The most common site of involvement is the left upper lobe (40% to 50%), followed by the right middle lobe (30% to 40%), and right upper lobe (20%) [1]. Diagnosis can be made in utero or shortly after birth. If the presentation is respiratory distress and pulmonary lobar hyperinflation, excision of the affected lobe by video-assisted thoracic surgery is the appropriate treatment [2].


   References
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 References
 

  1. Mendeloff EN. Sequestrations, congenital cystic adenomatoid malformations, and congenital lobar emphysema Semin Thorac Cardiovasc Surg 2004;16:209-214.[Medline]
  2. Cano E, Anton-Pacheco JL, Garcia A, Rothenberg S. Video-assisted thoracoscopic lobectomy in infants Eur J Cardiothorac Surg 2006;29:997-1000.[Abstract/Free Full Text]




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