Giant lobar emphysema detected in an infant

Abstract

This study reports the case of a two-month-old male infant born to a first-degree marriage. Cesarean section was performed due to oligohydramnios and the infant received required vaccines. The initial interview conducted with parent’s highlighted dyspnea after delivery. For 14 days, he had had dry cough associated with wheezing progressing in a context of apyrexia. Clinical examination showed conscious, apyretic infant with HR 140 bpm, FR 51 cpm, SpO2 99% breathing 1 L/min with signs of respiratory distress such as substernal intercostal retraction with decreased left vescicular murmur, bilateral basithoracic sibilant sounds and crackles in the left region. Cardiovascular auscultation showed heart sounds deviated to the left side without heart murmur. The patient didn’t have abdominal distension. Chest X-ray showed distention of the left lung with lucency of the entire left lung and visible vascularization. It was associated with transmediastinal hernia as well as displacement of the mediastinal structures on the contralateral side and right pulmonary atelectasis. Radiological findings suggested giant emphysema in the left lobe, diaphragmatic hernia, dextrocardia and viral bronchiolitis. Angioscan showed giant emphysema in the left upper lobe. Echocardiography and abdominal ultrasound were normal. Left upper lobectomy was performed associated with anatomopathological examination, which confirmed the diagnosis of emphysema. The postoperative course was uneventful. Clinical and radiological outcomes were satisfactory after a 2month follow-up period.