Single-stage bilateral lobectomy for bilateral congenital lobar emphysema: A case report

Introduction

Congenital lobar emphysema (CLE) is a condition characterized by overinflation of one or more pulmonary lobes due to air-trapping, which can cause severe compression of adjacent structures. Bilateral CLE is rare but can cause severe respiratory distress.

Case presentation

A 9-day-old female born at 38 weeks who had respiratory distress since birth was transferred to our institution for further care. The prenatal history was unremarkable. Bloodwork was within normal limits.

She was put on non-invasive continuous positive airway pressure. On physical exam she had decreased air entry over the lower two-thirds of the lung fields bilaterally. A chest x-ray revealed air trapping in the left upper hemithorax and the right lower hemithorax. Contrast-enhanced computed tomography confirmed bilateral CLE of the left upper lobe and the right middle lobe causing severe compression of the adjacent lobes. She was intubated and transferred to the intensive care unit. Due to concerns regarding adherence to follow up and further access to medical care, we decided to attempt a single-stage bilateral thoracotomy/lobectomy. On day of life 15 she was taken to the operating room. We first did a left thoracotomy and a left upper lobectomy. The operation was uneventful, and she remained hemodynamically stable throughout the case. We closed the left thoracotomy and decided to proceed with a right thoracotomy and right middle lobectomy. She tolerated that procedure well. She was extubated in the operating room and was transferred to the intensive care unit. She recovered well and was discharged from the hospital on no respiratory support on postoperative day 13. Six months after the operation she remains asymptomatic and is thriving well.

Conclusion

In a resource-limited setting with poor parental adherence for follow-up, single-stage bilateral thoracotomy is a viable option for the management of bilateral congenital lobar emphysema.