Deficiency of cartilage in the segmental bronchi of a child: Congenital or acquired?

Elfeldt, R. J.; Schmidt, Dietmar; Thies, J. E.; Schröder, D; Seiffert, Peter

doi:10.1016/0003-4975(94)92262-4

Cited by 3 publications

(1 citation statement)

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“…There are many reports on the different histopathologic features of CLE. Some investigators reported cartilage deficiency, dysplasia at the bronchial level and bronchial atresia (1,5,16), others have suggested hyperplasia or hypoplasia of alveoli (8,14). Polyalveolar lobe was also reported (3,12).…”

Section: Discussionmentioning

confidence: 99%

Congenital Lobar Emphysema: A Clinicopathologic Evaluation of 14 Cases

Tander

Yalçın²,

Yılmaz³

et al. 2003

Eur J Pediatr Surg

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Controversy still exists concerning the diagnosis and treatment of congenital lobar emphysema (CLE). Although surgical removal of the affected lobe is the most commonly accepted form of treatment, detection of milder or even asymptomatic cases is usually followed by a more conservative management of patients, i. e. non-surgical treatment and follow-up. We therefore decided to evaluate our patients with CLE, placing special emphasis on treatment and diagnostic techniques. We also evaluated quantitative analyses of alveolar diameters. Fourteen children with CLE were analysed retrospectively, including age, sex, clinical picture, localisation, diagnostic and surgical modalities and histopathologic diagnosis. The alveolar diameters of affected lobes were compared with those of the lobectomised patients with other non-obstructive respiratory diseases. All children but one had severe respiratory distress as an initial symptom. All patients, except newborns, had a history of pulmonary infection. All cases underwent thoracic CT examination as the main radiologic method. In all of the patients, only one lobe was affected. We found an obvious mediastinal shift and atelectasis of adjacent lobes due to compression of the affected lobe. The affected lobe was therefore surgically removed in all of the children. In one case, we had to carry out a partial lobectomy to reduce the duration of the operation, due to an intraoperative fall of oxygen saturation. All of the children had an uneventful clinical course postoperatively. The alveolar diameters of the cases with CLE were significantly greater than those of the control patients. We think that the majority of cases with CLE have too severe respiratory distress to avoid surgical removal of affected lobe. Conservative management should be reserved only for patients with milder symptoms or no distress at all.

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