Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

Authors

  • Asif Iqbal Department of Pediatric Surgery, The Children's Hospital and University of Child Health Sciences, Lahore
  • Naeem Liaqat Department of Pediatric Surgery, Rawalpindi Medical University, Rawalpindi
  • Muhammad Saleem The Chidren's Hospital & University of Child Health Sciences, Lahore
  • Nabila Talat The Chidren's Hospital & University of Child Health Sciences, Lahore
  • Arsalan Raza Wasti Department of Paediatric Surgery, Jinnah Hospital, Lahore
  • Muhammad Ammar Department of Paediatric Surgery, The Chidren's Hospital & University of Child Health Sciences, Lahore
  • Imran Hashim Department of Paediatric Surgery, The Chidren's Hospital & University of Child Health Sciences, Lahore

DOI:

https://doi.org/10.46831/jpas.v1i2.10

Keywords:

Congenital Lobar Emphysema;, Child, Pneumonia, Intubation

Abstract

Background: Congenital Lobar emphysema (CLE) is one of the rarest cystic lesions in the thoracic cavity among children. It is often misdiagnosed and managed incorrectly. We are reporting our institutional experience and recommendations regarding the prevention of common errors in the management of this condition.

Methods: This study was conducted at the Paediatric Surgery Department, The Children’s Hospital & the University of Child Health Sciences Lahore from January 2015 to December 2018. All the patients who underwent thoracotomy for congenital lobar emphysema at our center were included in the study and their charts were reviewed. 

Results: A total of 19 patients had been treated at our center in this duration. The mean age of patients was 2.85 ± 2.11 months. Thirteen of them (68%) were male and the most common presenting complaint (94.7%) was respiratory distress. Chest X-ray was done in all of the patients while a CT scan was needed in 11 patients (57.9%). The most involved lobe was left upper (n=15). Lobectomy was done in all patients. Post-operative ventilation was required in 2 patients (10.5%) and pneumonia developed in 2 patients (10.5%). The most significant complication was wound infection (9/19, p=<0.01).

Conclusion: Our results about perioperative management are consistent, however, we received cases with misdiagnosis. We have proposed recommendations to address this issue.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Asif Iqbal, Department of Pediatric Surgery, The Children's Hospital and University of Child Health Sciences, Lahore

Senior Registrar

Naeem Liaqat , Department of Pediatric Surgery, Rawalpindi Medical University, Rawalpindi

Consultant 

Muhammad Saleem, The Chidren's Hospital & University of Child Health Sciences, Lahore

Prof. of Paediatric Surgery/Medical Director

Nabila Talat , The Chidren's Hospital & University of Child Health Sciences, Lahore

Prof. of Paediatric Surgery/Head of the Department unit-II

Arsalan Raza Wasti, Department of Paediatric Surgery, Jinnah Hospital, Lahore

Prof. of Paediatric Surgery/Head of the Department

Muhammad Ammar, Department of Paediatric Surgery, The Chidren's Hospital & University of Child Health Sciences, Lahore

Post Graduate Trainee

Imran Hashim , Department of Paediatric Surgery, The Chidren's Hospital & University of Child Health Sciences, Lahore

Associate Prof. Paediatric Surgery 

References

Badiu I, Hiriscau A, Lupan I, Samasca G. Congenital lobar emphysema in infants. Maedica. 2017; 12:133-5.

Cataneo DC, Rodrigues OR, Hasimoto EN, Schmidt AF, Jr., Cataneo AJ. Congenital lobar emphysema: 30-year case series in two university hospitals. Jornal brasileiro de pneumologia: publicação oficial da Sociedade Brasileira de Pneumologia e Tisiologia. 2013; 39:418-26.

Nazem M, Hosseinpour M. Evaluation of early and late complications in patients with congenital lobar emphysema: a 12 year experience. Afr J Paediatr Surg. 2010; 7:144-6.

Giudici R, Leao LE, Moura LA, Wey SB, Ferreira RG, Crotti PL. [Polyalveolosis: pathogenesis of congenital lobar emphysema?]. Revista da Associacao Medica Brasileira (1992). 1998; 44:99-105.

von Ranke FM, Freitas HMP, Dinoá V, Miraldi F, Marchiori E. Congenital lobar emphysema. Radiologia brasileira. 2018; 51:205-6.

Chinya A, Pandey PR, Sinha SK, Sarin YK. Congenital lobar emphysema: Pitfalls in diagnosis. Lung India: official organ of Indian Chest Society. 2016; 33:317-9.

Kunisaki SM, Saito JM, Fallat ME, St. Peter SD, Kim AG, Johnson KN, et al. Current operative management of congenital lobar emphysema in children: A report from the Midwest Pediatric Surgery Consortium. J Pediatr Surg. 2019; 54:1138-42.

Kumar S, Debata PK, Gupta R. Congenital lobar emphysema and intercostal drainage tube insertion: the common fate of an uncommon disease. J Clin Diag Res. 2012; 6:1568-70.

Powers JE, Counselman FL. Congenital lobar emphysema: tube thoracostomy not the treatment. Pediatr Emer Care. 2005; 21:760-2.

Prabhu SM, Choudhury SR, Solanki RS, Shetty GS, Agarwala S. Inadvertent chest tube insertion in congenital cystic adenomatoid malformation and congenital lobar emphysema-highlighting an important problem. Ind J Radiol Imag. 2013; 23:8-14.

Seear M, Townsend J, Hoepker A, Jamieson D, McFadden D, Daigneault P, et al. A review of congenital lung malformations with a simplified classification system for clinical and research use. Pediatr Surg Int. 2017; 33:657-64.

Mohamed EEH, Mohamed Abdel Ghaffar AM, Abdel-Aal KM, Helmy AA, Ashry M. Surgical management of congenital lobar emphysema: A 15 years experience in a tertiary thoracic surgery unit. J Egypt Soc Cardiothorac Surg. 2018; 26:308-17.

Makhijani AV, Wong FY. Conservative post-natal management of antenatally diagnosed congenital pulmonary airway malformations. J Paediatr Child Heal. 2018; 54:267-71.

Ng C, Stanwell J, Burge DM, Stanton MP. Conservative management of antenatally diagnosed cystic lung malformations. Arch Dis Childhood. 2014; 99:432-7.

Ulku R, Onat S, Ozçelık C. Congenital lobar emphysema: differential diagnosis and therapeutic approach. Pediatr Int. 2008; 50:658-61.

Tempe DK, Virmani S, Javetkar S, Banerjee A, Puri SK, Datt V. Congenital lobar emphysema: pitfalls and management. Annals of cardiac anesthesia. 2010; 13:53.

Azizkhan RG, Crombleholme TM. Congenital cystic lung disease: contemporary antenatal and postnatal management. Pediatr Surg Int. 2008; 24:643-57.

Published

2021-08-20

How to Cite

1.
Iqbal A, Liaqat N, Saleem M, Talat N, Wasti AR, Ammar M, Hashim I. Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management. J Pediatr Adolesc Surg [Internet]. 2021Aug.20 [cited 2021Oct.18];1(2):80-3. Available from: http://jpedas.org/ojs/index.php/jpedas/article/view/jpas-10
Share |

Most read articles by the same author(s)

1 2 > >>