Congenital lobar emphysema misdiagnosed as bronchiolitis in 8-month-old infant: a case report
Safa’a Taleb, Alhasan Rastanawi, Youssef Chouman, Aya Saada, Sawssan Ali, Maher AlAllounIntroduction:
Congenital lobar emphysema (CLE) is characterized by excessive overexpansion of one or more lung lobes without alveolar damage and is caused by inadequate bronchial cartilage, which leads to air trapping during expiration. This results in hyperinflation, overdistention, and near-complete non-function of the affected lobe. CLE is rare, with a postnatal incidence of 1 in 20 000–30 000 live births; the prenatal incidence remains unknown. Presentation ranges from incidental or asymptomatic discovery to severe, life-threatening respiratory distress (tachypnea, retractions, nasal flaring, grunting).
Case presentation:
An 8-month-old female infant had worsening dyspnea and respiratory distress for approximately 2 months. Initial treatment failed due to the misdiagnosis of CLE as bronchiolitis. A subsequent computed tomography (CT) scan revealed the typical findings of CLE, and the patient was treated by surgical resection of the affected lobe.
Discussion:
Our case is significant because CLE rarely presents after 6 months of age (in only 5% of cases), which can lead to misdiagnosis as bronchiolitis or pneumonia. Our case underscores the importance of maintaining a clinical suspicion of CLE in infants with progressive respiratory distress unresponsive to treatment and highlights the need for radiological investigations to avoid invasive procedures, such as unnecessary intercostal drainage tube insertion, due to a mistakenly identified pneumothorax.
Conclusion:
In infants with progressive, treatment-resistant respiratory distress, maintain a high suspicion for CLE. Pursue advanced imaging (e.g., CT) early to identify lung anomalies and avoid unnecessary invasive procedures, such as chest tube insertion.