Massive Lobar Emphysema in Infants: Diagnosis and Treatment

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MASSIVE lobar emphysema in infants deserves more widespread recognition, because it requires emergency surgical treatment. The condition is readily diagnosed, and if untreated may prove fatal. Surgical removal of the involved lung tissue is lifesaving.


The disease may be recognized clinically from the history, physical examination, and roentgenograms. In general the history is that of a baby who was normal at birth but in whom respiratory distress developed within the first few weeks of life. Often the respiratory distress is intermittent and is precipitated by feeding or by crying. It is characterized by dyspnea, wheezing, grunting, coughing, and cyanosis. As the disease progresses the dyspnea and cyanosis become profound and the infant may die of respiratory failure.

The physical findings are those of emphysema. The child breathes with difficulty with flaring of the ala nasi and retraction of the costal cartilages. Breathing is audibly difficult, and an expiratory wheeze is commonly heard. The breath sounds are diminished on the diseased side, sometimes having an amphoric quality. Crackling rales may be heard on both sides in addition to the expiratory wheeze.

Excitement, or the greater respiratory effort associated with feeding or crying may cause cyanosis. The portion of thorax over the involved side is more prominent than that over the uninvolved side. The excursion of the chest wall during respiration is limited. The percussion note is hyperresonant, although this fact may be difficult to demonstrate in the normally resonant infant's chest. Laryngeal stridor is not present. The heart is displaced . . .



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