Congenital lobar emphysema

it is case presentation of a child presenting with shortness of breath at 14th day of life

1. Case presentation Dr. Hafiz Mahmood Ahmad

2. History Patient name: XYZ Father Name : XYZ Age : 14 days Sex: Male Adress : Multan D.O.B: 14-10-16 D.o.A : 27-10-16

3. Presenting Complaint Shortness of Breath 2 days post birth

4. History of present illness Patient developed the complaint of shortness of breath 2 days post birth and presented to a consultant at Multan Hospital where he was diagnosed as having the pneumothorax secondary to pneumonia and was intubated. Antibiotics were started for pneumonia treatment

5. Pre intubation Xray

6. Post Intubation Xray

7. History of present illness But it didn’t relieve his shortness of breath Patient was referred to lahore for the management and presented to paeds medicine emergency Mayo Hospital Lahore His Chest tube was taken out and patient was put on ventilator on CMV mode for 24 hours Call was sent to the Paeds surgery Department meanwhile

8. Examination On examination patient was tachyponeic Trachea was shifted to the right Percussion note was hyper resonant on left side Air entry was reduced on left side

9. Suspected Diagnosis Congenital lobar emphysema involving left upper lobe of lung was made which is present in 40-50% of congenital lobar emphysema due to suspected herniation of lung across midline on Xrays CPAM was other differential diagnosis

10. Suspected midline herniation

11. Suspected Midline Herniation

12. CT scan was advised

13. Left upper lobe “popping out “ of thoracotomy wound

14. Left upper lobe “popping out “ of thoracotomy wound

15. Left upper lobe “popping out “ of thoracotomy wound

16. Left upper lobe “popping out “ of thoracotomy wound

17. Emphysematous Lobe with air trapped inside

18. AFFECTED lOBe being mobilized

19. AFFECTED lOBe being mobilized

20. Post excision of the affected lobe

21. Post excision of the affected lobe

22. Post excision of the affected lobe

23. Affected LObe

24. Affected lobe

25. Post Op Recovery Was smooth Patient discharged on 5 th post op day

26. Post intubation Xray

27. Discussion Causes of CLE: Dysplastic bronchial Cartilage Endo bronchial obstruction from inssipisated mucus or extensive mucosal bronchial atresia Extrinsic compession of bronchi by abberant vessels Diffuse Bronchial Abnormalities

28. Frequency of cle Left uppper Lobe (40-50%) Right middle lobe (30-40%) Right upper Lobe (20%) Lower lobes 1%

29. Age of diagnosis At birth 25% In first year of life 50% Sporadic after 6 monts

30. Test to diagnose Pre natal ultrasound Ultrafast fetal MRI Chest xray CT scan Xenon Radio isoptope scan

31. Pre op management High frequency ventilation Selective Bronchial Intubation Endoscopic Decompression of emphysema

32. Definite Mangement Thoracotomy and segmentectomy