The patient, a 14 day old male, presented with shortness of breath two days after birth. He was diagnosed with pneumothorax secondary to pneumonia and intubated. His condition did not improve, so he was referred to another hospital. There, imaging suggested congenital lobar emphysema of the left upper lobe. He underwent surgery where the affected lobe was excised. His post-op recovery was smooth and he was discharged on the fifth post-op day.

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

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

27. POST INTUBATION XRAY

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