Polialveolose: patogênese do enfisema lobar congênito?

Giudici, Roseli; Leão, Luiz Eduardo Villaça; Moura, Luiz Antônio Ribeiro de; Wey, Sérgio Barsanti; Ferreira, Rimarcs Gomes; Crotti, Pierre

doi:10.1590/s0104-42301998000200006

Cited by 4 publications

(5 citation statements)

References 17 publications

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“…Although more than 50% of all CLE cases have no clear etiology, several theories have been proposed to explain the mechanism of air trapping in the emphysematous lung, including the presence of bronchial cartilage dysplasia,( 7 , 30 ) accumulation of mucus or redundant mucosa leading to valve obstruction, extrinsic compression by aberrant bronchi or vascular structures, infection-related abnormalities,( 14 ) and polyalveolar lobe. ( 5 , 6 ) Contrary to what many authors have reported, we found no cartilaginous changes in the bronchi of the emphysematous lobe.…”

Section: Discussionmentioning

confidence: 99%

“…Apesar de mais de 50% dos casos não apresentarem uma etiologia definida, várias teorias foram propostas para explicar o mecanismo de retenção aérea no pulmão enfisematoso, como presença de cartilagens brônquicas displásicas,( 7 , 30 ) acúmulo de muco ou redundância de mucosa, levando a obstrução valvular, compressão extrínseca por brônquios aberrantes ou estruturas vasculares, anomalias relacionadas a infecção( 14 ) e polialveolose. ( 5 , 6 ) Em nenhum dos nossos casos foram encontradas alterações cartilaginosas nos brônquios do lobo enfisematoso, como referem muitos autores, mas essas não podem ser totalmente excluídas, pois poderia haver uma alteração na emergência do brônquio, a qual não é ressecada com a peça.…”

Section: Discussionunclassified

“…( 6 ) Some Brazilian authors have also reported polyalveolar lobe as the cause of CLE on the basis of histological studies involving alveolar counts, having shown an increase in the number of alveoli per area of lung tissue. ( 7 ) It is difficult to differentiate between CLE and hyperinflation resulting from extrinsic bronchial obstruction (lymph nodes, vessels, masses, or cysts) that compresses the bronchus and produces valve obstruction. In such cases, hyperinflation should be designated acquired lobar emphysema; however, more than 50% of all CLE cases are unrelated to airway abnormalities.…”

Section: Introductionmentioning

confidence: 99%

“…( 6 ) Alguns autores brasileiros também descreveram a presença de lobo polialveolar como causa do ELC, baseado em estudos histológicos com contagem alveolar, mostrando um aumento no número de alvéolos por área de tecido pulmonar. ( 7 ) É difícil a diferenciação do ELC com hiperinsuflações resultantes de obstruções brônquicas extrínsecas (linfonodos, vasos, massas ou cistos) que comprimem o brônquio e produzem obstrução valvular. Nesses casos, a hiperinsuflação deveria ser chamada de enfisema lobar adquirido; entretanto, mais de 50% dos casos de ELC não são relacionados a nenhuma anomalia das vias aéreas.…”

Section: Introductionunclassified

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Congenital lobar emphysema: 30-year case series in two university hospitals

et al. 2013

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OBJECTIVE: To review the cases of patients with congenital lobar emphysema (CLE) submitted to surgical treatment at two university hospitals over a 30-year period. METHODS: We reviewed the medical records of children with CLE undergoing surgical treatment between 1979 and 2009 at the Botucatu School of Medicine Hospital das Clínicas or the Mogi das Cruzes University Hospital. We analyzed data regarding symptoms, physical examination, radiographic findings, diagnosis, surgical treatment, and postoperative follow-up. RESULTS: During the period studied, 20 children with CLE underwent surgery. The mean age at the time of surgery was 6.9 months (range, 9 days to 4 years). All of the cases presented with symptoms at birth or during the first months of life. In all cases, chest X-rays were useful in defining the diagnosis. In cases of moderate respiratory distress, chest CT facilitated the diagnosis. One patient with severe respiratory distress was misdiagnosed with hypertensive pneumothorax and underwent chest tube drainage. Only patients with moderate respiratory distress were submitted to bronchoscopy, which revealed no tracheobronchial abnormalities. The surgical approach was lateral muscle-sparing thoracotomy. The left upper and middle lobes were the most often affected, followed by the right upper lobe. Lobectomy was performed in 18 cases, whereas bilobectomy was performed in 2 (together with bronchogenic cyst resection in 1 of those). No postoperative complications were observed. Postoperative follow-up time was at least 24 months (mean, 60 months), and no late complications were observed. CONCLUSIONS: Although CLE is an uncommon, still neglected disease of uncertain etiology, the radiological diagnosis is easily made and surgical treatment is effective.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionunclassified

Section: Introductionmentioning

confidence: 99%

Section: Introductionunclassified

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Congenital lobar emphysema: 30-year case series in two university hospitals

et al. 2013

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“…[3] However, there has been an alternate theory of hyperalveolosis, according to which the increased num-ber of alveoli leads to hyperinflation of the affected lobe. [4] The affected lobe is hyperinflated, which ultimately becomes non-functional because of excessive air trapping. Due to this, the mediastinum is shifted to the contralateral side, which leads to bilateral functional compromise and eventually leading to respiratory distress, cyanosis, and repeated pneumonia, which may be the typical feature in this disease.…”

Section: Introductionmentioning

confidence: 99%

Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

Iqbal

Liaqat

Saleem³

et al. 2021

J Pediatr Adolesc Surg

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Background: Congenital Lobar emphysema (CLE) is one of the rarest cystic lesions in the thoracic cavity among children. It is often misdiagnosed and managed incorrectly. We are reporting our institutional experience and recommendations regarding the prevention of common errors in the management of this condition. Methods: This study was conducted at the Paediatric Surgery Department, The Children’s Hospital & the University of Child Health Sciences Lahore from January 2015 to December 2018. All the patients who underwent thoracotomy for congenital lobar emphysema at our center were included in the study and their charts were reviewed. Results: A total of 19 patients had been treated at our center in this duration. The mean age of patients was 2.85 ± 2.11 months. Thirteen of them (68%) were male and the most common presenting complaint (94.7%) was respiratory distress. Chest X-ray was done in all of the patients while a CT scan was needed in 11 patients (57.9%). The most involved lobe was left upper (n=15). Lobectomy was done in all patients. Post-operative ventilation was required in 2 patients (10.5%) and pneumonia developed in 2 patients (10.5%). The most significant complication was wound infection (9/19, p=<0.01). Conclusion: Our results about perioperative management are consistent, however, we received cases with misdiagnosis. We have proposed recommendations to address this issue.

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A Case of Congenital Lobar Emphysema: Challenges in Diagnosis and in Anaesthetic Management

Bisht¹,

Dubey²,

Narasimha³

2015

jebmh

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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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Polialveolose: patogênese do enfisema lobar congênito?

Cited by 4 publications

References 17 publications

Congenital lobar emphysema: 30-year case series in two university hospitals

Congenital lobar emphysema: 30-year case series in two university hospitals

Congenital lobar emphysema in children: Institutional experience and errors to be avoided in the management

A Case of Congenital Lobar Emphysema: Challenges in Diagnosis and in Anaesthetic Management

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