Which findings on radiographs are characteristic of congenital lobar emphysema (CLE)?

Updated: Apr 08, 2019
  • Author: Beverly P Wood, MD, MSEd, PhD; Chief Editor: John Karani, MBBS, FRCR  more...
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Answer

Answer

See the radiographic images of congenital lobar emphysema below.

A frontal radiograph of the chest in a neonate sho A frontal radiograph of the chest in a neonate shows marked overdistention of the left upper lobe with mediastinal shift to the right.
Anteroposterior chest radiograph shows overexpansi Anteroposterior chest radiograph shows overexpansion of the right middle lobe in a patient aged 18 months with suspected asthma.
Lateral chest radiograph shows anterior herniation Lateral chest radiograph shows anterior herniation of the right middle lobe.
Two-year-old patient with respiratory distress sho Two-year-old patient with respiratory distress shows left upper lobe hyperaeration.
Lateral chest radiograph with mild midline herniat Lateral chest radiograph with mild midline herniation of the left upper lobe.
Swyer-James syndrome. with growth decreasing in on Swyer-James syndrome. with growth decreasing in one lung after infection.
The left upper lobe is affected in 41% of patients The left upper lobe is affected in 41% of patients with congenital lobar emphysema.

A large, hyperlucent lung with attenuated but defined vascularity is observed. Compression of the remaining lung on that side, flattened hemidiaphragm, and widened intercostal spaces also are seen. An involved lung is seen herniated across the anterior midline. On a lateral view, the heart is displaced posteriorly with retrosternal lucency representing an anteriorly herniated lobe.

The lobe is unchanged during exhalation or after placing the patient in the ipsilateral decubitus position. Chest fluoroscopy shows fixed lung and hemidiaphragm on the involved side. The radiographic appearance is characteristic of congenital lobar emphysema (CLE) and usually is not suggestive of other diagnoses.


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