Ball valve obstruction of a bronchus causing lobar emphysema in a neonate

Abstract

Lobar emphysema in the neonate is usually congenital, resulting from cartilage deficiency causing bronchomalacia and distal air trapping. Acquired forms are usually associated with chronic lung disease or endobronchial obstruction such as mucus plugging. We report a pedunculated endobronchial polyp in a 2-month old ex-premature infant causing intermittent hyperinflation of the right middle lobe. The polyp was seen prolapsing in and out of the bronchus intermedius at bronchoscopy. Possible aetiological links with mechanical ventilation are discussed. We also emphasise the value of bronchoscopy prior to lobectomy in cases of congenital lobar emphysema (CLE).

An Unusual Presentation of Congenital Lobar Emphysema

“…New techniques, such video-assisted thoracoscopy, promise a safer and faster surgical approach for this condition [12]. Bronchoscopy prior to any the surgical procedure tends to be very rewarding, as it permits the confirmation of bronchomalacia and continues with the planned surgical approach, or in some cases, find an extrinsic mass or endobronchial obstruction, and avoid lobectomy [13]. …”

Congenital tracheal polyp in a neonate: first case in literature

“…To date, in our knowledge, congenital tracheal polyp in either childhood or in neonatal age has never been reported. In the neonatal period and infancy endobronchial inflammatory polyps were reported in few cases and all cases had been ventilated for long time (5)(6)(7). In our patient, symptoms were present at birth and ventilation was continued only for five days so we do not consider the ventilation process was effective in the etiology of polyp.…”

A proposed CT classification of progressive lung parenchymal injury complicating pediatric lymphobronchial tuberculosis: From reversible to irreversible lung injury

“…It is important to compare the parenchymal complications of LBTB with the parenchymal changes seen in airway obstruction due to other causes as there are no longitudinal studies to inform the sequence of events in LBTB. Intraluminal foreign bodies are well known to cause air trapping 25 by a ball‐valve mechanism 15,26 . Extraluminal or endoluminal tumors also obstruct airways giving rise to a spectrum of parenchymal changes ranging from consolidation , atelectasis , 12 and drowned lung 19,27 to multiple fluid‐filled cavities , 16 necrosis , and cavity formation 14…”

“…Intraluminal foreign bodies are well known to cause air trapping 25 by a ball-valve mechanism. 15,26 Extraluminal or endoluminal tumors also obstruct airways giving rise to a spectrum of parenchymal changes ranging from consolidation, atelectasis, 12 and drowned lung 19,27 to multiple fluid-filled cavities, 16 necrosis, and cavity formation. 14 Even though there are no longitudinal follow-up studies to prove progression of one complication to another, the pathogenetic mechanisms known from other causes of obstruction and the underlying severity of the parenchymal changes, suggest a progressive evolution in severity towards lung destruction.…”