10 months old boy with 1 week of fever and cough.

CXR shows relatively translucency of a hyper-expanded right upper lobe.  No radiopaque foreign body.  No focal consolidation detected.

Selected axial and coronal images from contrast-enhanced CT in lung windows confirm the suspicion of a hyper-expanded right upper lobe.  No endoluminal mass lesion or foreign body was identified within the airways (not demonstrated on these images).

1. Congenital lobar emphysema.

2. Aspirated foreign body / endobronchial lesion

Congenital lobar emphysema.

Congenital lobar emphysema represents the final, common pathway of a variety of causes disrupting normal bronchopulmonary development, resulting in progressive over-expansion of a pulmonary lobe.  In terms of lobar predilection, statistically the left upper lobe is most commonly affected, followed by the middle lobe, right upper lobe then the lower lobes.

Patient management often requires bronchoscopy to exclude an endobronchial lesion / aspirated foreign body.  Patients with minimal symptoms may be managed conservatively, though lobectomy is indicated in cases of progressive hyper-expansion and respiratory distress.