Nonoperative Management of Lobar Emphysema

Roghair, Garry D.

doi:10.1148/102.1.125

Cited by 13 publications

(3 citation statements)

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“…21,27 Long-term imaging studies have reported improvement in NOP managed children. 24,28 This finding was also observed in our study with radiography improvement even in the severe cases (Figure 1). To assess the long-term effect of the NOP approach, the children in this group were followed for a median period of 4 years and some were followed until adolescence.…”

Section: Discussionsupporting

confidence: 89%

“…There is evidence for favorable long‐term outcomes for NOP management with small case reports showing normal growth rate of the functional lung tissue in both treatment cohorts 21,27 . Long‐term imaging studies have reported improvement in NOP managed children 24,28 . This finding was also observed in our study with radiography improvement even in the severe cases (Figure 1).…”

Section: Discussionsupporting

confidence: 82%

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The long‐term outcomes of symptomatic congenital lobar emphysema patients

Gatt

Lapidus-Krol

Chiu

2023

Pediatric Pulmonology

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Introduction Surgical (OP) management for symptomatic congenital lobar emphysema (CLE) is the standard of care with nonoperative (NOP) approach applied for asymptomatic cases. The aim of this study is to report the outcomes for NOP approach to the care of symptomatic CLE infants. Methods A retrospective study of CLE patients treated 2000−2021 at a single institution. Patients with CLE and respiratory symptoms were included. Results Overall, 23 children had symptomatic CLE, and 12 had NOP management. The median age at diagnosis was 38.5 days (50) in the NOP group versus 25 days (20) in the OP group (p = 0.31). There was no significant difference in the location of the involved lobe, term birth, postnatal diagnosis and gender, and both groups required noninvasive support in 33% of the cases. There was a trend towards higher frequency of oxygen support in the OP group preoperatively (89% vs. 42%, p = 0.07). The median length of stay was 14 days in the NOP group compared to a median postsurgery stay of 7.5 days in the OP group. In follow‐up, there was no significant difference in respiratory readmission in first year of life, growth delay, treatment with asthma medication or body mass index in the NOP versus OP group. None of the children in the NOP group required surgery during follow‐up. Conclusions A NOP approach for symptomatic CLE infants can have favorable long‐term outcomes. Further studies will be required to identify markers to aid in clinical decision‐making.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionsupporting

confidence: 82%

The long‐term outcomes of symptomatic congenital lobar emphysema patients

Gatt

Lapidus-Krol

Chiu

2023

Pediatric Pulmonology

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“…Bei einer entsprechenden Größe führt das kongenitale lobäre Lungenemphysem sehr schnell zu einer bedrohlichen Ateminsuffizienz die eine Lobektomie des betroffenen Lungenlappens erforderlich macht (EHRENHART u. TABER 1953). Andererseits zeigen Einzelbeobachtungen, daß das kongenitale lobäre Lungenemphysem auch stationär bleiben und sich sogar zurückbilden kann (ROGHAIR 1972;SHANNON et al 1977).…”

Section: Kongenitales Lobäres Lungenemphysemunclassified

Die Thoraxerkrankungen des Neugeborenen

Oppermann¹

1989

Handbuch Der Medizinischen Radiologie / Encyclopedia of Medical Radiology

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Congenital lobar emphysema: Evaluation and long‐term follow‐up of thirty cases at a single center

Özçeli̇k

Göçmen

Ki̇per

et al. 2003

Pediatric Pulmonology

102

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Congenital lobar emphysema (CLE) is characterized by overdistension and air-trapping in the affected lobe, and is one of the causes of infantile respiratory distress. In this report, we review our 27 years of experience with 30 CLE patients. Patients' medical records were evaluated with regard to age, clinical presentation, diagnostic methods, associated diseases, treatment, histopathologic findings, and final clinical and laboratory findings at the end of a long-term period. The mean age of 30 patients (18 male) at diagnosis was 4.9 +/- 6.7 months (range, 2 days-2.5 years). Tachypnea, dyspnea, cough, cyanosis, wheezing, hoarseness, and decreased breath sounds on the affected side were the main symptoms and clinical findings. On chest X-rays, emphysema was seen in all patients; shift/herniation to the opposite lung, atelectasis, and pneumothorax were observed in 16, 5, and 2 cases, respectively. Computerized tomography of the thorax was performed in 16 cases and revealed emphysema at affected lobe/lobes in all, a shift/herniation to the opposite side in 12 cases, and atelectasis of neighbor lobe/lobes in 7 cases. All 8 patients who had perfusion scintigraphy showed reduced perfusion in the affected lobe. Narrowed and flaccid bronchi were detected in one patient by using flexible bronchoscopy. Blood gas analysis was performed in 11 patients, and hypoxia and hypercarbia were revealed in 9 and 7 of these patients, respectively. The most common affected lobe was the left upper lobe (57%), followed by the right upper lobe (30%) and right middle lobe (27%). Two lobes were involved in 4 patients. Associated abnormalities were observed in 5 patients. Twenty-one patients underwent lobectomy; 9 were followed conservatively. Ages at diagnosis were significantly younger in surgically treated patients. Emphysema was detected in all pathological specimens, with an additional bronchial cartilage deficiency in 2 patients. In the surgically treated group, 2 patients died and 2 patients were lost to follow-up. In the conservatively treated group, one patient was lost to follow-up. Mean follow-up duration of all patients was 63.2 +/- 56.2 months (range, 1-209 months). At follow-up visits, all patients were doing well. In surgically treated patients, chest X-rays were normal (9 cases), or showed hyperlucency on the operated side (6 cases) or chronic changes in the operation area (2 cases). Hyperexpansion in the affected lobe was found to be reduced in all cases in the conservatively treated group.

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Nonoperative Management of Lobar Emphysema

Cited by 13 publications

References 0 publications

The long‐term outcomes of symptomatic congenital lobar emphysema patients

The long‐term outcomes of symptomatic congenital lobar emphysema patients

Die Thoraxerkrankungen des Neugeborenen

Congenital lobar emphysema: Evaluation and long‐term follow‐up of thirty cases at a single center

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