Introduction Although uncommon, congenital lobar emphysema (CLE) is a potentially life threatening pulmonary abnormality affecting infants. Lobectomy, sometimes done under emergency conditions, is the universally accepted treatment of CLE with severe symptoms. However, in the developing world trained pediatric thoracic surgeons are not everywhere available. On the other hand, the use of flexible fiberoptic bronchoscopy (FFB) in children has shown an excellent safety record. Furthermore, it can be performed under sedation in most cases. We present here a case of CLE, in which we had been able to relieve the acute respiratory distress using FB.
Case presentation and procedure A distressed 4.5 months female infant was referred to us for repetitive prolonged bronchopneumopathy since birth. Successive chest X-rays showed increasing expansion and hyperlucency of right hemithorax, mediastinal shift, and compression of the left lung. At FFB the apicoposterior segmental bronchus of the right upper lobe (APSB/RUL) was narrow, flaccid and showed an expiratory check valve obstruction. By manipulating and rotating the bronchoscope tip into APSB/RUL and applying suction, we had succeeded to release the trapped air in the RUL. Clinical and radiological manifestations resolved completely following the procedure.
Conclusions In addition to the role it might play in the diagnostic workup of patients with CLE, FFB can be used as a tool for relief of obstruction. In certain situations, this may be life saving, especially in places and settings where emergency lobectomy cannot be arranged.