A newborn boy with respiratory distress, an opacified left hemithorax, and a mediastinal shift

A case is described of a newborn boy admitted to the hospital with a mass in the left side of the chest and respiratory distress. The boy had been born the previous day in a different hospital. During pregnancy, the mother had high blood pressure, but the history of medications she used was not complete. She denied using drugs or alcohol or smoking during pregnancy. The baby was delivered vaginally at 37 weeks gestation. When he was brought to the hospital on the day after birth, he was placed in the special-care nursery and given oxygen for respiratory distress. Chest X-rays showed an opacity of the left lung and a shift of the mediastinum, the structure of tissues separating the lungs. Other examinations included listening to breath sounds and analysis of blood gases, as well as evaluation of heart function. Over the first several days in the hospital, his respiratory distress improved, but lung function did not become normal. One possible diagnosis was congenital lobar emphysema involving retention of fluid in the affected lung. Surgery was performed and a part of the left lung was removed. In response to this procedure, the rest of the left lung expanded, and the baby had a good recovery. Examination of the lung tissue removed showed an abnormal structure of the airways in part of the lung, which was diagnosed as polyalveolar lobe of lung. This condition is sometimes described as a type of congenital lobar emphysema, but whether it is truly emphysema is controversial. Seven months later, the infant was well, with normal lung function. (Consumer Summary produced by Reliance Medical Information, Inc.)