Congenital Lobar Emphysema: a Diagnostic Challenge

ZY Joazlina, ML Wastie, JA De Bruyne

Hong Kong J Radiol 2005;8:105-8

Congenital lobar emphysema is an abnormality of the lung of unknown aetiology that can present a diagnostic and therapeutic dilemma. This report describes a neonate with respiratory distress for whom an initial diagnosis of meconium aspiration syndrome was made. Congenital lobar emphysema of the upper lobe of the left lung with collapse and consolidation of the upper lobe of the right lung was eventually diagnosed at age 3 months following X-ray, computed tomography, and scintigraphy examinations. A left thoracotomy and left upper lobectomy was performed at age 3.5 months. The patient improved dramatically and the postoperative period was uneventful; postoperative chest X-rays showed resolution of the right upper lobe changes. Histological examination of the resected lobe showed normal bronchial cartilage of the major airways and distended alveoli. A thorough evaluation of the patient’s history, consideration of the differential diagnosis of respiratory distress, re-evaluation of chest radiographs, and computed tomography are helpful in difficult cases or for early diagnosis of congenital lobar emphysema.