Congenital lobar emphysema: Diagnosis and management

Abstract

Dear Editor, This is with reference to case report titled “Anaesthetic management of children with congenital lobar emphysema: A report of two cases”. (MJAFI 2005; 61:79-81). 1 In congenital lobar emphysema (CLE), the clinical manifestations become apparent in the neonatal period but may be delayed for as long as 5-6 months in 5% of patients. Congenital deficiency of bronchial cartilage, external compression by aberrant vessels, bronchial stenosis and redundant bronchial mucosal flaps have been described as leading to bronchial obstruction and subsequent CLE. In the present case report, both cases presented at 6 weeks of age. In both cases, the authors describe secretions, as tenacious, viscid and purulent in one case and requiring repeated tracheal suctioning in both the cases. This gives rise to a doubt about the diagnosis, as mucous plug obstruction (with ball valve effect permitting inflow of air but obstructing outflow) could give rise to similar clinical and radiological picture. A histopathological study of the resected specimen is the only way to differentiate congenital from acquired etiology. 2 The routine use of prenatal ultrasonography has resulted in early identification and serial evaluation of congenital lung lesions. CLE can be distinguished from other congenital lung lesions on ultrasonography by differences in echogenicity and reflectivity. This helps in identification and surgical management of the anomaly during neonatal period. 3 The fall in temperature of the infant during surgery in the second case highlights the importance of paying special attention to maintenance of temperature during surgery in neonates and infants. The various measures needed include warmed operating rooms, warmed parenteral solutions and fluids and covering exposed parts of the baby especially the head. Involving a pediatrician skilled in neonatal care and ventilation may have helped in avoiding the complications which these babies suffered intraoperatively.