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Congenital lobar emphysema
- 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
- 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
- 12. CT scan was advised
- 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. LEFT UPPER LOBE “POPPING OUT “ OF THORACOTOMY WOUND
- 18. EMPHYSEMATOUS LOBE WITH AIR TRAPPED INSIDE
- 19. AFFECTED LOBE BEING MOBILIZED
- 20. AFFECTED LOBE BEING MOBILIZED
- 21. POST EXCISION OF THE AFFECTED LOBE
- 22. POST EXCISION OF THE AFFECTED LOBE
- 23. POST EXCISION OF THE AFFECTED LOBE
- 24. AFFECTED LOBE
- 25. AFFECTED LOBE
- 26. POST OP RECOVERY Was smooth Patient discharged on 5th post op day
- 28. DISCUSSION Causes of CLE: 1. Dysplastic bronchial Cartilage 2. Endo bronchial obstruction from inssipisated mucus or extensive mucosal bronchial atresia 3. Extrinsic compession of bronchi by abberant vessels 4. Diffuse Bronchial Abnormalities
- 29. FREQUENCY OF CLE Left uppper Lobe (40-50%) Right middle lobe (30-40%) Right upper Lobe (20%) Lower lobes 1%
- 30. AGE OF DIAGNOSIS At birth 25% In first year of life 50% Sporadic after 6 monts
- 31. TEST TO DIAGNOSE Pre natal ultrasound Ultrafast fetal MRI Chest xray CT scan Xenon Radio isoptope scan
- 32. PRE OP MANAGEMENT High frequency ventilation Selective Bronchial Intubation Endoscopic Decompression of emphysema
- 33. DEFINITE MANGEMENT Thoracotomy and segmentectomy