A Case of Congenital Lobar Emphysema in the Middle Lobe
A 3-week-old male baby weighing 2300 g was referred to our neonatal intensive care unit for asphyxia with respiratory distress not responding to medical management in regional hospital. His mother did not have any follow-up during her pregnancy. He was delivered as a full term with delayed cry and respiratory distress.\nPhysical examination revealed a tachypneic baby with flaring of alae nasi and sub costal retraction, the cyanosis was generalized (oxygen saturation spO2 was 70% in air). On examination of the respiratory system, decrease breath sound on the left hemithorax was noted. The cardiac auscultation was normal.\nThe chest X-ray showed hyperinflation on the right side, and right basithoracic opacity []. computed tomography (CT) scan of the thorax supported the X-ray []. There was hyperinflation on the right middle lobe with tracheal and mediastinal shift to the left side. The blood parameters were normal. On the echocardiography, there was no evidence of congenital cardiac anomalies.\nAfter hemodynamic stabilization of the child, surgical intervention was performed. The right middle lobe looked emphysematous at time resection []. Post-operative chest X-ray showed expansion of the right upper and lower lobes, with no emphysema or mediastinal shift.\nHistopathological examination of the excised right middle showed alveolar distension without fibrosis [].\nThe child was discharged 7 days post-surgical intervention, and he was seen as an out-patient for follow-up. He had normal O2 saturation in room air and he was feeding well.