Congenital lobar emphysema (CLE) is a rare clinical entity presenting as acute respiratory distress in infants. Its diagnosis is difficult as clinically and radio logically it mimics pneumonia or pneumothorax. Its early recognition and management with thoracotomy is lifesaving. Inhalation induction is preferred and spontaneous ventilation should be maintained until either the chest is opened or one lung ventilation of the contralateral lung is achieved. In this case report, we describe the challenges faced in the anaesthetic management of this condition. KEYWORDS: Congenital lobar emphysema, hyperinflation, thoracotomy, endobronchial intubation, positive pressure ventilation. KEYMESSAGES: In a neonate presenting with respiratory distress, the possibility of congenital lobar emphysema (CLE), a rare clinical entity should be kept in mind. Thoracotomy and complete lobectomy are lifesaving in CLE. Inhalation induction with endobronchial intubation is the preferred mode of anaesthetic management.
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