Congenital segmental emphysema: an evolving lesion.
BACKGROUND
Congenital segmental emphysema (CSE) is a newly-recognised sub-type of congenital parenchymal lung anomaly. It is characterised by antenatal detection and post-natal evolution from an initially solid segmental appearance to a hyperlucent and hyperinflated segment.


METHODS
A retrospective review of a single-centre tertiary referral database between Jan 1994 and Dec 2007 was performed.


RESULTS
130 infants had antenatally detected lung anomalies, and of these 12 (9.2%) infants (initially labelled as congenital cystic adenomatoid malformation (CCAM)), showed features better defined as CSE. The lesions were described antenatally as non-progressive microcystic (n=6), hyperechogenic (n=2) or both (n=2). Early post-natal CT scans showed areas of solid segmental parenchyma, initial hyperlucency or microcysts. Subsequent CT imaging, however, showed evolution to segmental hyperlucency in areas previously solid and in 2 cases a central bronchocele was noted. Ten children underwent resectional surgery (segmentectomy n=4, lobectomy n=6) at a median age of 1 (range 0.4-5.2) year and the gross appearance of the resected specimen confirmed hyperinflated (not cystic) segments. Histological review showed localised abnormally dilated alveolar spaces in 7 cases. Adjacent areas consistent with type 2 CCAM were also seen (n=3).


CONCLUSIONS
CSE lies within the spectrum of both CCAM and sequestration but there is a definite post-natal evolution and volume change which presage symptoms. This may be associated with segmental bronchial atresia and progressive air trapping via collateral airways such as the interalveolar pores of Kohn.
Paramalingam
S
S
King's College Hospital, Paediatric Surgery, London, United Kingdom.
Parkinson
E
E
Sellars
M
M
Diaz-Cano
S
S
Nicolaides
K H
KH
Davenport
M
M
D006801:Humans; D011656:Pulmonary Emphysema / Q000473:pathology* / Q000601:surgery*; D015619:Respiratory System Abnormalities / Q000473:pathology* / Q000601:surgery*