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

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Abstract

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.

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Abbreviations

CLE:

Congenital lobar emphysema

FB:

Flexible bronchoscopy

BAL:

Bronchoalveolar lavage

CT:

Computed tomography

CHD:

Congenital heart disease

CPM:

Congenital pulmonary malformations

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Funding

No funding was secured for this study.

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Authors and Affiliations

  1. Department of Pediatric Pulmonology, Ankara City Hospital, University of Health Science, Üniversiteler District, 1604, Street No: 9, Çankaya, 06800, Ankara, Turkey

    Gökçen Dilşa Tuğcu, Sanem Eryılmaz Polat, Sule Selin Akyan Soydaş, Ece Ocak, Murat Yasin Gençoğlu, Salih Uytun, Satı Özkan Tabakçı & Güzin Cinel

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  1. Gökçen Dilşa Tuğcu
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  2. Sanem Eryılmaz Polat
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Contributions

GDT, SEP and GC contributed to the study design, analysis, interpretation of the results and drafted the manuscript. GDT, SEP, EO, SSAS, SU, MYG, SOT contributed to data collection and interpretation of the results and revision of manuscript. GDT, GC contributed to data collection, analysis and interpretation of the results. All authors critically revised the manuscript and approved the final version.

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Correspondence to Gökçen Dilşa Tuğcu.

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All authors declare that there is no support or financial disclosure from any organization for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years. There are no other relationships or activities that could appear to have influenced the submitted work. All authors have no conflicts of interest to disclosure.

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Tuğcu, G.D., Polat, S.E., Soydaş, S.S.A. et al. Surgery versus conservative management in congenital lobar emphysema: follow up and indicators for surgery. Pediatr Surg Int 38, 559–568 (2022). https://doi.org/10.1007/s00383-022-05086-2

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