Congenital Lobar Emphsema

To keep The bronchial orifices open, two factors are required:

    1- Recoil property of the bronchial tissue
    2- Pull out of the surrounding tissues.

As a matter of fact the bronchus is elongated and widened during inspiration and during expiration it is shortened and narrowed. If this property is disturbed, the air will enter easily during inspiration but it will be partially trapped during expiration, so emphysematous changes will gradually develop. The condition usually manifests itself at birth as fetal distress.

Review of chest x-ray of different cases showed emphysema of the upper lobe of the left lung with herniation through the mediastinum to the other side and shift of the mediastinum to the opposite side as well.

 (click on the image to enlarge)

In Lateral views, notice the widening of the retro-sternal space.
(click on the image to enlarge)

These pictures showed emphysema of the upper lobe of the right lung. notice the shift of the mediastinum to the other side, collapse of the middle lobe and basal segments of the lower lobe.

Normally through thoracotomy incision, the lung tissue can NOT be brought out above the level of the incision. But In case of emphysema it will bulge out by itself as soon as we open the chest.

 

If the lesion is confined to a broncho-pulmonary segment, it will be lobular emphysema

Images of operative shots (click on the image to enlarge)

Images of naked eye and cut section of the specimen  (click on the image to enlarge).

In infants, most of the time, an emergency surgical  intervention is required. The anesthetist  colleague will not agree because of the poor blood gases parameters.

The only way to improve the condition is just by opening the chest. As soon as we open the chest the emphysematous tissue will bulge out. As the intra-thoracic pressure decreases, the venous return and cardiac output will improve and blood gases parameters will improve as well.

END