Infantile Lobar Emphysema

Infantile lobar emphysema is a symptom complex representing a spectrum of diseases characterized by overdistention of a pulmonary lobe by a check valve mechanism. The earlier in life infantile lobar emphysema presents, the more severe are the symptoms. Half of the cases appear in the first 4 weeks of life. The chest radiograph is the best diagnostic tool but can be misinterpreted. Computed tomography sometimes discloses the cause, which appears to be bronchial obstruction in 25% of cases. The bronchial obstruction may be due to intrinsic defects or to extrinsic compression. Bronchoscopy should be performed only in certain cases and then only with careful anesthetic management.

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RADIOLOGIC AID IN REGIONAL AND GENERALIZED EMPHYSEMA OF THE LUNGS IN INFANTS

PEDIATRICS ◽

10.1542/peds.24.6.1050 ◽

1959 ◽

Vol 24 (6) ◽

pp. 1050-1064

Author(s):

Edwin J. Liebner

Keyword(s):

Pulmonary Infection ◽

Main Bronchus ◽

Check Valve ◽

Valve Mechanism ◽

Extrinsic Factors ◽

Plain Films ◽

Regional Basis ◽

Roentgenographic Study ◽

Lobar Emphysema ◽

Pathologic Processes

Normally, the bronchi dilate rapidly in inspiration and contract slowly in expiration, thus effecting a form of check-valve mechanism. Intra-and extra-bronchial occlusion, pulmonary infection, developmental bronchopulmonary malformations and pleural communications are pathologic processes which can disturb the check-valve mechanism and produce increased aeration. [See Figure in Source Pdf.] The main bronchus and artery may be obstructed separately, or as a unit. Angiocardiograms should be analyzed for abnormal patterns, especially obstruction or atresia. A lack of vascular markings in the lungs can suggest pseudo-increased aeration. On a regional basis, roentgenographic study of the vascular and air patterns can lead to recognition of certain entities. An angiogram in congenital lobar emphysema contrasts the vascular pattern in the involved and the remaining normal and unaffected lobes with pneumatocele, cystic disease, and atelectasis. Reasons for support of the deficient-cartilage theory as a cause of lobar emphysema are cited, with emphasis on the localization of the emphysema to the anterior or upper lobes. Bronchiolitis can give total compensatory emphysema, and the reasons given will help to understand the roentgenographic findings. Regional compensatory emphysema of the remaining lung, after total or partial collapse of a lobe by intrinsic or extrinsic factors, is illustrated. Basal pneumothorax is indicated to be a significant postoperative complication. Although at times great similarity may exist in the appearance of plain films in conditions producing increased aeration of infants' lungs, it is hoped that this review will stimulate deeper analyses and wider recognition of the fundamentals.

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An Unusual Presentation of Congenital Lobar Emphysema

Case Reports in Pulmonology ◽

10.1155/2017/6719617 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Daniel Arnaud ◽

Joseph Varon ◽

Salim Surani

Keyword(s):

Computed Tomography ◽

Ct Scan ◽

Chest Radiograph ◽

Lung Parenchyma ◽

Unusual Presentation ◽

Exertional Dyspnea ◽

Congenital Lobar Emphysema ◽

Good Outcome ◽

Alveolar Septum ◽

Lobar Emphysema

Congenital lobar emphysema is an uncommon bronchopulmonary malformation characterized by lobar overinflation and accompanying alveolar septum damage that leads to compression atelectasis of the lung parenchyma and displacement of mediastinal structures, with the resultant ventilation-perfusion mismatch. We present a case of a 33-year-old lady with progressive exertional dyspnea. Chest radiograph findings lead to the suspicion of congenital lobar emphysema, which was then confirmed by a computed tomography (CT) scan. This condition is most commonly identified in newborns, with very few cases being reported in adults. Lobectomy remains the treatment of choice and in general has good outcome.

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Basal Cerebral Computed Tomography as Diagnostic Tool to Improve Patient Selection in Asymptomatic Carotid Artery Stenosis

Angiology ◽

10.1177/0003319711431448 ◽

2011 ◽

Vol 63 (7) ◽

pp. 504-508 ◽

Cited By ~ 3

Author(s):

Felice Pecoraro ◽

Ettore Dinoto ◽

Domenico Mirabella ◽

Giuseppe Corte ◽

Umberto Marcello Bracale ◽

...

Keyword(s):

Computed Tomography ◽

Carotid Artery ◽

Patient Selection ◽

Diagnostic Tool ◽

Carotid Artery Stenosis ◽

Asymptomatic Carotid ◽

Improve Patient Selection ◽

Cerebral Computed Tomography ◽

Asymptomatic Carotid Artery Stenosis ◽

Improve Patient

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Digital tomosynthesis as a new diagnostic tool for assessing of chronic gout arthritic feet and ankles: comparison of plain radiography and computed tomography

Clinical Rheumatology ◽

10.1007/s10067-017-3710-x ◽

2017 ◽

Vol 36 (9) ◽

pp. 2095-2100 ◽

Cited By ~ 2

Author(s):

Chang-Nam Son ◽

Yoonah Song ◽

Sang-Hyon Kim ◽

Seunghun Lee ◽

Jae-Bum Jun

Keyword(s):

Computed Tomography ◽

Diagnostic Tool ◽

Plain Radiography ◽

Digital Tomosynthesis ◽

Chronic Gout

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Giant bulla formation in the lung because of a check-valve mechanism

Respiratory Investigation ◽

10.1016/j.resinv.2016.10.006 ◽

2017 ◽

Vol 55 (1) ◽

pp. 63-68 ◽

Cited By ~ 1

Author(s):

Aya Hirata ◽

Takeshi Saraya ◽

Nobuaki Arai ◽

Shin Karita ◽

Riken Kawachi ◽

...

Keyword(s):

Check Valve ◽

Valve Mechanism ◽

Giant Bulla

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Diurnally fluctuating frontal dysequilibrium secondary to a pineal pilocytic astrocytoma: is this symptom associated with a check-valve mechanism in a pineal region tumor?

Child s Nervous System ◽

10.1007/s00381-008-0738-x ◽

2008 ◽

Vol 25 (3) ◽

pp. 367-371 ◽

Cited By ~ 1

Author(s):

Tae-Won Kim ◽

Tae-Kyu Lee ◽

Bum-Soo Kim ◽

Kwang-Soo Lee ◽

In-Uk Song ◽

...

Keyword(s):

Pilocytic Astrocytoma ◽

Check Valve ◽

Pineal Region ◽

Valve Mechanism ◽

Pineal Region Tumor

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NON-SURGICAL TREATMENT OF UNILOBAR OBSTRUCTIVE EMPHYSEMA OF THE NEWBORN

PEDIATRICS ◽

10.1542/peds.14.4.296 ◽

1954 ◽

Vol 14 (4) ◽

pp. 296-304

Author(s):

HERBERT W. KORNGOLD ◽

JOHN M. BAKER

Keyword(s):

Surgical Treatment ◽

Segmental Resection ◽

Bronchial Obstruction ◽

Surgical Method ◽

New Born ◽

Poor Risk ◽

Lobar Emphysema ◽

Non Surgical Treatment

1. The reported 22 cases of unilobar obstructive emphysema in infancy are reviewed. Eighteen of these cases were successfully treated by lobectomy or segmental resection. No cause of the obstruction was found in over 50% of the cases reported. 2. Two cases of unilobar obstructive emphysema in the newborn are presented. These patients were successfully treated by selectively decompressing the emphysematous lobe. 3. The non-surgical method of treatment is advocated in the newborn when lobar emphysema is newly established and reversible. It may be of value when surgery is indicated to improve the patient who is a poor risk. 4. The mechanism, by which selective decompression alleviates the partially obstructed bronchus, is open to conjecture. However, we postulate that the bronchus, is kinked by an overdistended emphysematous lobe and that retained viscid secretions augment the bronchial obstruction in the new born.

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Selective Computed Tomography–guided Perisciatic Injection as a Diagnostic Tool in Multiple Hereditary Exostoses

Orthopedics ◽

10.3928/01477447-20120822-38 ◽

2012 ◽

Vol 35 (9) ◽

pp. e1446-e1448 ◽

Cited By ~ 1

Author(s):

Shay Tenenbaum ◽

Harel Arzi ◽

Nogah Shabshin ◽

Boaz Liberman ◽

Israel Caspi

Keyword(s):

Computed Tomography ◽

Diagnostic Tool ◽

Multiple Hereditary Exostoses

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Utility of Chest Computed Tomography after a “Normal” Chest Radiograph in Patients with Thoracic Stab Wounds

The American Surgeon ◽

10.1177/000313481508101011 ◽

2015 ◽

Vol 81 (10) ◽

pp. 965-968 ◽

Cited By ~ 4

Author(s):

Brian M. Nguyen ◽

David Plurad ◽

Sadaf Abrishami ◽

Angela Neville ◽

Brant Putnam ◽

...

Keyword(s):

Computed Tomography ◽

Chest Radiograph ◽

Tube Thoracostomy ◽

Diagnostic Strategy ◽

Stab Wounds ◽

Chest Computed Tomography ◽

Future Studies ◽

Normal Chest Radiograph ◽

Normal Chest ◽

Level I

Chest computed tomography (CCT) is used to screen for injuries in hemodynamically stable patients with penetrating injury. We aim to determine the incidence of missed injuries detected on CCT after a negative chest radiograph (CXR) in patients with thoracic stab wounds. A 10-year retrospective review of a Level I trauma center registry was performed on patients with thoracic stab wounds. Patients who were hemodynamically unstable or did not undergo both CXR and CCT were excluded. Patients with a negative CXR were evaluated to determine if additional findings were diagnosed on CCT. Of 386 patients with stab wounds to the chest, 154 (40%) underwent both CXR and CCT. One hundred and fifteen (75%) had a negative screening CXR. CCT identified injuries in 42 patients (37%) that were not seen on CXR. Pneumothorax and/or hemothorax occurred in 40 patients (35%), of which 14 patients underwent tube thoracostomy. Two patients had hemopericardium on CCT and both required operative intervention. Greater than one-third of patients with a normal screening CXR were found to have abnormalities on CCT. Future studies comparing repeat CXR to CCT are required to further define the optimal diagnostic strategy in patients with stab wounds to chest after normal screening CXR.

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