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Shakil 1month 20 days old infant 1st issue of a
nonconsanguinous parents has been admitted on 13th
July 2009 with the complaints of respiratory distress
for 20 days. According to the mother¶s statement her
child was alright upto 1month of his age. Then he
developed respiratory distress which was associated
with cough and cold.
?ontd.
For those complaints the infant was treated by a local
physician as patient¶s condition was not improving with
oral medication he referred the patient to DSH for
further evaluation and subsequent management.Patient
has no H/O bluish discoloration,fever, convulsion and
choking attack during feeding.Regarding birth history
patient was delivered by NVD at term at hospital
without any perinatal complications. Patient was on
exclusive breast feeding on demand.
?ontd.
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Patient was dyspnoeic,afebrile,not cyanosed .R/R-
62/min,H/R-130/min,Temp-98°F.Respiratory
system examination revealed intercostal and
subcostal recession,trachea palpable towards right
side,apex beat was located on left 4th I?S near to
the midline.On percussion whole left lung was
hyper resonant and normal on right side,on
auscaltation breathsound was diminished on left
lung field ,vocal resonance was also diminished
on the same area and there was normal vesicular
breath sound on auscultation of right lung.Other
systemic examination findings were normal

  






  

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?Hypertranslucent left lung with
mediastenal shifting towards right side.
?? :
Done outside and it was within normal limit.
? :0.9mg/L
!: Normal.
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V Right sided collapse consolidation with left sided
compensatory emphysema.
V ?ongenital lobar emphysema
V ?ongenital cystadenomatoid malformation
V Foreign body aspiration(Left bronchus)
 
  
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First managed in ward then referred to I? .
V Oxygen inhalation by mask
V NG tube feeding
V I/V infusion.
V Injectable antibiotics
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?T scan of chest.
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?T scan showed a hyperluscent, hyper extended lobe
with midline substantial herniation and compression
of the remaining lung . The mediastinum is
significantly shifted away from the side of the
abnormal lobe.
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V ?ongenital lobar emphysema (?LE) can result in
severe respiratory distress in early infancy and is
most often detected in neonates or identified during
in utero ultrasound; however, less severely affected
patients may present in infancy or childhood.
V ?LE almost always involves one lobe with rates of
recurrence:
Lt upper lobe 41%
Rt middle lobe 34%
Rt upper lobe 21%

V ?ongenital lobar emphysema (?LE) presents with
overexpansion of a pulmonary lobe and resultant compression
of the remaining ipsilateral lung. A mediastinal shift away from
the increased-volume lung can also compress the contralateral
lung.
V The 

  is related to


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: In these cases, there is
weakened or absent bronchial cartilage, so that there is
inspiratory air entry but collapse of the narrow bronchial lumen
during expiration. This bronchial defect results in lobar air
trapping.
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, such as by a large
pulmonary artery, affected cartilage rings are malformed, soft,
and collapsible in response to the long-term in utero extrinsic
effect.

V Extreme lobar overdistention is life-threatening.
V  
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"  may be required if the lobe
cannot be decompressed by selective intubation of the
opposite side or by placing the infant in the decubitus
position with the involved lobe dependent.
V In severely affected patients, the lung is overinflated
and will immediately herniate through the surgical
incision.
V Less severely affected patients are managed
conservatively with gentle ventilation and monitoring
to ensure that respiratory status does not worsen.
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