Pediatric emergency medicine trisk 4100 4100
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Infants with CLE are often normal in appearance at birth, but develop tachypnea,
cough, wheezing, dyspnea, and/or cyanosis within a few days. The onset of
symptoms may be more gradual; nevertheless, 80% of patients are symptomatic
by 6 months of age. The upper lobes are involved in about two-thirds of patients.
Chest radiographs show striking radiolucency in the involved lobe with
mediastinal shift to the opposite side. The diaphragm is usually flattened on the
affected side. It can be difficult to tell whether pulmonary markings are present in
the involved lobe, and pneumothorax may be suspected. The compressed normal
lung may be erroneously believed to be atelectatic with the emphysematous lobe
compensatory.
Management
Initially, the clinical presentation and physiologic derangements may be similar to
that of tension pneumothorax, and the two entities should be distinguished.
Physical examination may reveal an asymmetric thorax, unilateral
hyperresonance and decreased breath sounds on the affected side, and evidence of
mediastinal shift. Typical findings on chest radiograph include lobar
overinflation, contralateral shift of the mediastinum, and collapse of lung tissue
on the contralateral side, with flattening of the ipsilateral hemidiaphragm ( Fig.
124.9 ). In a stable patient, CT or ventilation/perfusion scanning can be helpful in
establishing the diagnosis.
FIGURE 124.10 Operative findings in a child with congenital lobar emphysema.
