Surgery versus conservative management in congenital lobar emphysema: follow up and indicators for surgery

Introduction Congenital lobar emphysema (CLE), a rare developmental lung malformation, involves the hyperaeration of one or more lung lobes caused by partial obstruction and occurs at a rate of 1/20,000–30,000 live births. Here, we aimed to retrospectively examine the clinical, radiological, and bro...

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Bibliographic Details
Published in:Pediatric surgery international 2022-04, Vol.38 (4), p.559-568
Main Authors: Tuğcu, Gökçen Dilşa, Polat, Sanem Eryılmaz, Soydaş, Sule Selin Akyan, Ocak, Ece, Gençoğlu, Murat Yasin, Uytun, Salih, Tabakçı, Satı Özkan, Cinel, Güzin
Format: Article
Language:English
Subjects:
Adolescent
Age
Bronchoscopy
Child
Child, Preschool
Congenital diseases
Conservative Treatment
Emphysema
Follow-Up Studies
Foreign bodies
Hospitals
Humans
Infant
Infant, Newborn
Medicine
Medicine & Public Health
Original Article
Patients
Pediatric Surgery
Pediatrics
Pulmonary Emphysema - congenital
Pulmonary Emphysema - diagnostic imaging
Pulmonary Emphysema - surgery
Retrospective Studies
Surgery
Tomography
Ultrasonic imaging
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Summary:Introduction Congenital lobar emphysema (CLE), a rare developmental lung malformation, involves the hyperaeration of one or more lung lobes caused by partial obstruction and occurs at a rate of 1/20,000–30,000 live births. Here, we aimed to retrospectively examine the clinical, radiological, and bronchoscopy findings of patients with CLE who were diagnosed and treated by surgical or non-surgical (conservative) approaches at our center and compared our results with those in the literature. Methods We examined the clinical, radiological, and bronchoscopy findings of 20 patients with CLE aged 0–18 years at our center between 2013 and 2020. In addition, we examined the symptoms and findings recorded during the patients’ follow-up in this retrospective descriptive study. Results The median age of 20 patients with CLE at diagnosis was 3.2 years (range 1 day–17 years). Respiratory distress and mediastinal shift were more prominent in patients who underwent surgery, and they were diagnosed at an earlier age compared with patients who were followed up conservatively ( p  = 0.001, 0.049, 0.001, respectively). Neither the pulmonary lobe involvement nor the bronchoscopy findings were found to be indicative of surgery. Discussion We observed that respiratory distress and mediastinal shift were more prominent in patients with a diagnosis of CLE who underwent surgery compared with patients who were conservatively followed up. Moreover, we observed that those who underwent surgery were diagnosed with CLE at an earlier age. In line with the literature, the pulmonary symptoms and CLE-related imaging findings in our study were reduced during conservative follow-up.
ISSN:0179-0358
1437-9813
DOI:10.1007/s00383-022-05086-2