PEDIATRICS Vol. 34 No. 2 August 1964, pp. 246-255
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INFANTILE LOBAR EMPHYSEMA

Lucian L. Leape M.D.1 and Luther A. Longino M.D.1

1 Surgical Service, Children's Hospital Medical Center, and the Department of Surgery, Harvard Medical School, Boston, Massachusetts

Infantile lobar emphysema is being recognized with increasing frequency as a cause of respiratory distress in early infancy. Symptoms may be present from birth, sometimes in a rapidly progressive, quickly fatal form, or begin as late as the fourth month of life. The diagnosis should be considered in an infant with dyspnea with or without cyanosis, and is readily

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confirmed by the ordinary chest x-ray. Further diagnostic tests are seldom needed.

The treatment is surgical resection of the emphysematous lobe. Medical therapy is of little value and uniformly unsuccessful in the neonatal period. Attempts at needle aspiration must be avoided, for these almost always result in a tension pneumothorax which can be fatal.

Many factors have been incriminated as causing infantile lobar emphysema. These include bronchomalacia, bronchial stenosis, redundant bronchial mucosa, aberrant blood vessels, and other forms of bronchial obstruction, as well as intrinsic alveolar defects, either alone or in combination. Irrespective of cause, the clinical and x-ray pictures are uniform and diagnostic, and the treatment is always lobectomy.

Accepted on February 15, 1964


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