Congenital bilobar emphysema

Developmental lung malformations in children: recent advances in imaging techniques, classification system, and imaging findings

Congenital lung anomalies represent a diverse group of developmental malformations of the lung parenchyma, arterial supply, and venous drainage, which may present anywhere from the prenatal period through adulthood. It is imperative for radiologists to be aware of imaging techniques and imaging appearance of these anomalies across the pediatric age range. This review presents the spectrum of these lesions that are often encountered in daily clinical practice. Each anomaly is discussed in terms of underlying etiology, clinical presentation, and imaging characterization with emphasis on the most up-to-date research and treatment. Knowledge of these areas is essential for accurate, timely diagnosis, which aids in optimizing patient outcomes.

Congenital bilobar emphysema

Congenital bilobar emphysema is reported to be extremely rare. We describe 3 cases, and we review the diagnosis problems and treatment methods of this childhood respiratory tract pathologic condition.

Imaging Evaluation of Congenital Lung Abnormalities in Infants and Children

Congenital lung abnormalities include a wide spectrum of conditions and are an important cause of morbidity and mortality in infants and children. This article discusses focal lung abnormalities and the dysmorphic lung. Pulmonary arteriovenous malformations have been included at the end of the article. Anomalies affecting the pulmonary parenchyma, its arterial supply, and venous drainage are thus discussed.

The morphologic spectrum of infantile lobar emphysema: a study of 33 cases

Infantile lobar emphysema (ILE) is a relatively uncommon entity characterised by radiologic pulmonary lobar overinflation. The spectrum of underlying pathology in ILE has not been previously detailed. We have reviewed thirty-three cases of ILE accessioned to the Armed Forces Institute of Pathology, Washington D.C., since 1970. Seventeen (51.5%) presented in the first week of life, 27 (81.8%) presented within the first six months, and an additional six cases presented beyond six months including three beyond 18 months of age. Upper lobe involvement occurred in 96.9% cases and multiple lobes were involved in six cases. Nine infants had polyalveolar (hyperplastic) lobes determined on the basis of radial alveolar counts (RACs), while 21 were considered to be "classic ILE" since these showed lobar hyperexpansion without any other abnormality. RACs in infants with classic ILE remained fairly constant irrespective of age unlike a progressive increase seen in normal age-matched controls, suggesting a post-partum arrest of acinar development in ILE. Additional findings included serpiginous bronchioles resembling those seen in extralobar sequestration in two cases, bronchopulmonary dysplasia in two cases, and one case each showing "cystic alveoli" and peripheral subpleural cysts. ILE thus seems to be a composite of various pathologies resulting in a single clinical entity. We hypothesise that the timing of an inciting functional or anatomic bronchial obstruction during in-utero lung development determines morphologic variation in ILE.

Unilobar congenital pulmonary lymphangiectasis mimicking congenital lobar emphysema: an underestimated presentation?

BACKGROUND

Congenital lobar emphysema (CLE) is characterized by unilobar alveolar distension secondary to bronchomalacia or absent cartilage. In contrast, congenital pulmonary lymphangiectasis (CPL) is defined as distended lymphatics in the bronchovascular bundle, in the interlobular septa, and in the subpleural space. Little information is available regarding the radiologic presentation of CLE as it correlates with histological diagnosis.

METHODS

In a retrospective chart review from 1995 to 2002, 8 patients (5 boys and 3 girls) with clinical and radiologic diagnosis of CLE were reviewed.

RESULTS

The mean age at diagnosis was 26 months (range, 11 days to 10 years). All but one had classic respiratory symptoms of CLE. Six of 7 chest computed tomography (CT), scans were suggestive of CLE. Of 8 patients, 3 were treated without pulmonary resection with resolution of symptoms. Five patients underwent lobectomies, and histology results showed CPL in 3. CT failed to identify CPL in all cases.

CONCLUSIONS

Diagnosis of CLE is not as straightforward as the literature suggests. Even retrospectively, radiologic distinction between CLE and CPL could not be achieved by an experienced pediatric radiologist. CPL, thus, mimics CLE clinically and radiologically and, therefore, should be considered in the differential radiologic diagnosis of CLE.