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A case is presented which typifies the mild course of regional obstructive lung disease in the older child as contrasted with lobar emphysema of infancy with which it has been grouped. Regional obstructive lung disease as seen in children and adolescents presents a distinctly different symptom complex. The previously reported cases have been reviewed to emphasize the differences between and similarities to the well-recognized condition in the infant. Because of multiple areas of involvement, the term regional obstructive lung disease seems appropriate.The course in this age group appears to justify a more cautious approach to management.Although lobar emphysema in in¬ fancy has become a well-recog¬ nized entity since initial reports ap¬ peared, no effort has been made to describe the course in cases of simi¬ lar obstructive lung disease in school-age children and adolescents that have been reported. When these cases in school-age children and adolescents are compared, they pre¬ sent a distinct symptom complex which follows quite a different course from the symptom complex of the infant. In 1964, Leape and Longino J found more than 106 cases identified as lobar emphysema in infancy com¬ bining their own experience and the cases found in a review of the litera¬ ture. Only eight of these were chil¬ dren beyond infancy. Among large series which continue to be reported, there has been an occasional older patient. Report of a CaseThis 10-year-old white girl was seen initially because of restlessness in school. She was an adopted child, the product of a reportedly normal birth, but further family history was un¬ known. Significant past history includ¬ ed clinically diagnosed, mild bronchopneumonia at 4 months of age, mild respiratory infections, including occa¬ sional bronchitis before 3 years of age, and two bouts of otitis media. She had had chickenpox and rubeola modified by -globulin. The only hospitalization was at age 3 for a fractured clavicle. At that time a chest roentgenogram was reported as otherwise normal. Growth and development had been considered normal.Physical examination revealed a pre¬ pubertal girl who appeared well. Height was at the 50th percentile (141 cm) and weight at the 25th percentile (29 kg) on the Stewart growth chart. Vital signs were normal; there was no clubbing or respiratory distress. Significant findings included boggy nasal turbinâtes and a slight prominence of the left anterior chest wall with decreased breath sounds and hyperresonance to percussion in that area. The point of maximal cardiac impulse was palpable in the fifth intercostal space on the right at the midclavicular line, with the heart sounds being heard best over the right anterior side of the chest. There were no ad¬ ventitious sounds. Routine laboratory tests were not re¬ markable except for a 9% eosinophilia. Tuberculin and fungus skin tests showed negative results. Minimal left ventricular preponderance was suggest¬ ed by electrocardiogram. The chest roentgenogram showed an extensive, thin-walled, multicystic area an...