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DrAyushGoelandRishiAgrawaletal.
Congenitallobaroverinflation(CLO)(previosulycalledcongenitallobaremphysema)isa
congenitallungabnormalitythatresultsinprogressiveoverinflationofoneormorelobesofaneonate
lung.Variousmechanismshavebeenpostulatedincludinganobstructivecheckvalvemechanismatthe
bronchiallevel2.
Epidemiology
Congenitallobaroverinflationismorecommoninmales(M:F=3:1)5.
Clinicalpresentation
Patientstypicallypresentwithrespiratorydistress,mostcommonlyintheneonatalperiod,andusually
withinthefirst6monthsoflife5.
Pathophysiology
Incongenitallobaroverinflation,alobe(ormore)becomedistendedandmayormaynothavemore
alveoli.Therearemanypresumedmechanismsforprogressiveoverdistensionofalobeincluding
obstruction,cartilagedeficiency,dysplasia,andimmaturity.Mostcasesareidiopathic.
Associations
CLOmaybeassociatedwithcongenitalheartdefectssuchas:
ventricularseptaldefect(VSD)
patentductusarteriosus(PDA)
tetralogyofFallot
Radiographicfeatures
Interestinglythereisquiteapronouncedpredilectionforsomelobes:
leftupperlobe:mostcommon,4045%
rightmiddlelobe:30%
rightupperlobe:20%
mayinvolvemorethanasinglelobein5%
muchrarerinthelowerlobes.
Thereforedespitetheleftupperlobebeingmostcommonlyaffected,therighthemithoraxisthemost
commonsidetobeaffected6.
Plainfilm:chestradiograph
Immediatepostpartumperiod
Theaffectedlobetendstoappearopaqueandhomogeneousbecauseoffetallungfluidoritmayshow
adiffusereticularpatternthatrepresentsdistendedlymphaticchannelsfilledwithfetallungfluid.
Laterfindings
appearsasanareaofhyperlucencyinthelungwithapaucityofvessels
masseffectwithmediastinalshiftandhemidiaphragmaticdepression
decubitusfilmslyingontheaffectedsidewillshowlittleornochangeinlungvolume
lateralfilmmaydemonstrateposteriordisplacementoftheheart
CTchest
showsabovefeaturesingreaterdetail
attenuationofvascularstructuresinaffectedlobe4
mayalsoshowcompressiveatelectasisofneighbouringlobes
Treatment
Mildlysymptomaticpatientsareusuallyfollowedup.Alobectomycanbeconsideredinseverecases 3.
Differentialdiagnosis
Generalimagingdifferentialconsiderationsinclude:
congenitalcysticadenomatoidmalformation(CCAM)/congenitalpulmonaryairway
malformation(CPAM)
pulmonaryarterialhypoplasia
pulmonaryhypoplasia
bronchialatresia:thedistaltotheatreticsegmentcanhaveairtrapping
Seealso
differentialforunilateraltransradianthemithorax
http://radiopaedia.org/cases/congenital-lobar-emphysema