Current operative management of congenital lobar emphysema in children: A report from the Midwest Pediatric Surgery Consortium

J Pediatr Surg. 2019 Jun;54(6):1138-1142. doi: 10.1016/j.jpedsurg.2019.02.043. Epub 2019 Mar 1.


Purpose: The purpose of this study was to evaluate the clinical presentation and operative outcomes of patients with congenital lobar emphysema (CLE) within a large multicenter research consortium.

Methods: After central reliance IRB-approval, a retrospective cohort study was performed on all operatively managed lung malformations at eleven participating children's hospitals (2009-2015).

Results: Fifty-three (10.5%) children with pathology-confirmed CLE were identified among 506 lung malformations. A lung mass was detected prenatally in 13 (24.5%) compared to 331 (73.1%) in non-CLE cases (p < 0.0001). Thirty-two (60.4%) CLE patients presented with respiratory symptoms at birth compared to 102 (22.7%) in non-CLE (p < 0.0001). The most common locations for CLE were the left upper (n = 24, 45.3%), right middle (n = 16, 30.2%), and right upper (n = 10, 18.9%) lobes. Eighteen (34.0%) had resection as neonates, 30 (56.6%) had surgery at 1-12 months of age, and five (9.4%) had resections after 12 months. Six (11.3%) underwent thoracoscopic excision. Median hospital length of stay was 5.0 days (interquartile range, 4.0-13.0).

Conclusions: Among lung malformations, CLE is associated with several unique features, including a low prenatal detection rate, a predilection for the upper/middle lobes, and infrequent utilization of thoracoscopy. Although respiratory distress at birth is common, CLE often presents clinically in a delayed and more insidious fashion.

Level of evidence: Level III.

Keywords: Congenital lobar emphysema; Congenital lung malformations; Congenital pulmonary airway malformation.

MeSH terms

  • Child
  • Child, Preschool
  • Dyspnea
  • Humans
  • Infant
  • Midwestern United States / epidemiology
  • Pulmonary Emphysema / congenital*
  • Pulmonary Emphysema / epidemiology
  • Pulmonary Emphysema / surgery
  • Respiratory System Abnormalities
  • Retrospective Studies
  • Thoracoscopy / statistics & numerical data

Supplementary concepts

  • Congenital lobar emphysema