Congenital lobar hyperinflation

Case contribution: Dr Nurul Akhmar Omar

Clinical:

  • A 6 weeks old baby, born premature at 34 weeks
  • Noted tachypnoiec at birth and treated as congenital pneumonia
  • Presented again at 3 weeks old with respiratory distress. Persistent tachypnoe and need oxygen.

Chest radiograph findings:

  • An area of lucency is seen in the left mid and lower zones (yellow arrows).
  • Paucity of bronchopulmonary markings within the lucent region.
  • No obliteration of left hemidiaphragm.
  • Mediastinal shift to the right side (white arrow).
  • Trachea and the bronchi shadows are normal.
  • Nasogastric tube is seen in-situ.

CT scan findings:

  • The hyperinflated left lower lobe is confirmed
  • There is associated mediastinal shift to the right,
  • The left upper lobe is compressed
  • Segmental collapse consolidation of right lower lobe is also seen.
  • Bronchial tree is normal.

Diagnosis: Congenital lobar overinflation (CLO)

Discussion:

  • CLO is previously known as congenital lobar emphysema (CLE).
  • It is a congenital abnormality resulting in progressive overinflation of one or more lobules of a neonate‚Äôs lung.
  • It is more common in males.
  • Associations include: aberrant left pulmonary artery, VSD, PDA and tetralogy of Fallot.
  • Radiographic features:
    • During iImmediate postpartum period, the affected lobe tends to appear opaque and homogenous
    • Later findings include areas of hyperlucency in the lung with oligaemia (i.e paucity of vessels), mass effect with mediastinal shift and hemidiaphragmatic depression. A lateral view may show posterior displacement of the heart.
    • CT scan usually confirms the diagnosis and show greater detail of the mediastinal vascular structures, compressive atelectasis of adjacent lobes and attenuation of vascular structures in affected lobe.
  • Treatment depends on clinical symptoms. Patient with mild symptom is followed up. Those with severe symptoms may need surgical resection or lobectomy.
Author: radhianahassan