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Title: A case of Congenital Lobar Emphysema
Authors: ABIODUN, M.T
Issue Date: 2012
Publisher: Sri Lanka Journal of Child Health
Series/Report no.: 41 (3);146-147
Abstract: A two month old boy was admitted to the paediatric ward of the University of Benin Teaching Hospital, Nigeria with tachypnoea and poor suckling from the 4th hour of life and fever, cough and dyspnoea of two weeks duration. There was no grunting. He was delivered at term via spontaneous vertex delivery in a rural secondary health facility where mother received routine antenatal care. No obstetric- ultrasound scan was done. Immediate post partum period was normal. Birth weight was 3.1kg but he gained only 0.7kg over the next 2 months despite exclusive breastfeeding because respiratory distress interfered with suckling. He has received BCG, OPVI&2 and DPT1. Both parents are petty traders with secondary level of education. Physical examination revealed marked respiratory distress. Respiratory rate was 86 cycles per minute, pulse rate was 140 beats per minute and temperature was 38.7°C. There was normal facies and no cyanosis. His weight was 3.8kg (71% of expected), length was 56cm and head circumference 38cm, both normal for age. Respiratory system examination revealed mild bulging of the left hemithorax. Trachea was deviated to the right, percussion note was hyper-resonant and breath sounds were reduced in the left hemithorax. Apex beat was displaced medially to the left parasternal edge, at 4th intercostal space. Other systems were essentially normal. The initial diagnosis was bronchopneumonia complicated with a left-sided pneumothorax. Urgent chest radiograph (Figure la) showed hyperlucent, hyperinflated left upper lobe with reduced lung markings and collapse of the left lower lobe. There was herniation of the left upper lobe into the mediastinum causing a mediastinal shift to the right. Echocardiography showed no structural anomaly. A planned computerized tomography (CT) scan of the chest was unachieved due to financial constraints. Final diagnosis was congenital lobar emphysema (CLE). He received intravenous antibiotics, supplemental oxygen and other supportive care. He has improved on conservative management and the superimposed acute respiratory infection has resolved. He was planned for a lobectomy. Meanwhile, he is being followed up at the paediatric out -patient department.
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