Congenital Lobar Emphysema

Regional obstructive emphysema is not uncommon and is due in most cases to obstruction of a bronchus by secretions, tumour, foreign body or glands. Cohen (1943) described such a condition in association with a bronchial carcinoma and Spivek (1936) mentioned a similar picture in connexion with tuberculous glands. In such cases, however, the obstruction is usually progressive and leads finally to collapse of the affected lobe. Maxwell (1940) drew attention to the sign, which had been described by Chevalier Jackson, of an expiratory wheeze heard over an emphysematous lobe indicating an incomplete bronchial obstruction, and mentioned a case of a child aged 21 years who had progressive emphysema which subsided before bronchoscopy could be undertaken. Little has appeared in the English literature on the subject of lobar emphysema in infancy, the early onset of which suggests a congenital basis. The recent publication of several reports in the American literature of successful lobectomy for obstructive emphysema in infants has made the recognition and treatment of the condition of great interest and importance and suggests that it is more frequent than has hitherto been realized. The symptoms of the condition are fairly characteristic and consist of increasing attacks of dyspnoea and cyanosis. A history of such attacks calls for a radiograph of the chest which should be repeated a few days later if there is nothing apparent on the first film. The increasing emphysema of the affected lobe will gradually become more obvious both clinically and radiologically. The purpose of this article is to describe a case of congenital lobar emphysema in a newborn baby, which was also associated with a diaphragmatic abnormality, and to review the papers that have so far been published.