Congenitallobaroverinflation

DrAyushGoelandRishiAgrawaletal.
Congenitallobaroverinflation(CLO)(previosulycalledcongenitallobaremphysema)isa
congenitallungabnormalitythatresultsinprogressiveoverinflationofoneormorelobesofaneonate
lung.Variousmechanismshavebeenpostulatedincludinganobstructivecheckvalvemechanismatthe
bronchiallevel2.

Epidemiology
Congenitallobaroverinflationismorecommoninmales(M:F=3:1)5.

Clinicalpresentation
Patientstypicallypresentwithrespiratorydistress,mostcommonlyintheneonatalperiod,andusually
withinthefirst6monthsoflife5.

Pathophysiology
Incongenitallobaroverinflation,alobe(ormore)becomedistendedandmayormaynothavemore
alveoli.Therearemanypresumedmechanismsforprogressiveoverdistensionofalobeincluding
obstruction,cartilagedeficiency,dysplasia,andimmaturity.Mostcasesareidiopathic.
Associations
CLOmaybeassociatedwithcongenitalheartdefectssuchas:

ventricularseptaldefect(VSD)

patentductusarteriosus(PDA)

tetralogyofFallot

Radiographicfeatures
Interestinglythereisquiteapronouncedpredilectionforsomelobes:

leftupperlobe:mostcommon,4045%

rightmiddlelobe:30%

rightupperlobe:20%

mayinvolvemorethanasinglelobein5%

muchrarerinthelowerlobes.

Thereforedespitetheleftupperlobebeingmostcommonlyaffected,therighthemithoraxisthemost
commonsidetobeaffected6.
Plainfilm:chestradiograph
Immediatepostpartumperiod

Theaffectedlobetendstoappearopaqueandhomogeneousbecauseoffetallungfluidoritmayshow
adiffusereticularpatternthatrepresentsdistendedlymphaticchannelsfilledwithfetallungfluid.
Laterfindings

appearsasanareaofhyperlucencyinthelungwithapaucityofvessels

masseffectwithmediastinalshiftandhemidiaphragmaticdepression

decubitusfilmslyingontheaffectedsidewillshowlittleornochangeinlungvolume

lateralfilmmaydemonstrateposteriordisplacementoftheheart

CTchest

showsabovefeaturesingreaterdetail

attenuationofvascularstructuresinaffectedlobe4

mayalsoshowcompressiveatelectasisofneighbouringlobes

Treatment
Mildlysymptomaticpatientsareusuallyfollowedup.Alobectomycanbeconsideredinseverecases 3.

Differentialdiagnosis
Generalimagingdifferentialconsiderationsinclude:

congenitalcysticadenomatoidmalformation(CCAM)/congenitalpulmonaryairway
malformation(CPAM)

pulmonaryarterialhypoplasia

pulmonaryhypoplasia

bronchialatresia:thedistaltotheatreticsegmentcanhaveairtrapping

Seealso

differentialforunilateraltransradianthemithorax

Chest radiographs demonstrates increased translucency of the left

lung with mild mediastinal shift to the right side. On the lateral
projection the hyperlucency is confined to the left upper lobe,
shifting the oblique fissure posteroinferiorly.

Chest radiographs demonstrates increased translucency of the left

lung with mild mediastinal shift to the right side. On the lateral
projection the hyperlucency is confined to the left upper lobe,
shifting the oblique fissure posteroinferiorly.

The hyperinflated lobe

(outlined in blue) can be seen to displace the oblique fissure and the
mediastinum.

http://radiopaedia.org/cases/congenital-lobar-emphysema