The scheme of the diameter changes of the bronchi at Williams - Campbell syndrome on inhalation (a) and expiration (b).
Bronchogram of the left lung of the child with the Williams-Campbell syndrome.
Congenital lobar emphysema
Massive overinflation of one or more lung lobes occurs postnatally in congenital lobar emphysema. Causes include intrinsic absence or abnormality (bronchomalacia) of cartilaginous rings or external compression by a large pulmonary artery. (Compression of the cartilage usually leads to malacia.) Hyperexpansion of a pulmonary lobe is present after birth when, with negative inspiratory pressure, air can enter the lung. However, the air cannot exit easily because positive pressure causes the softened airway to collapse. The remaining normal lung is then compressed.
Congenital lobar emphysema on the right side of the chest in a neonate. There is marked lucent hyperexpansion in the middle lobe of the right lung; this finding is consistent with lobar emphysema. The possibility of tension pneumothorax is unlikely because lung markings are seen in this region, with splaying of the pulmonary vessels. Compressive atelectasis is present in the left upper and right lower areas of the lungs. The mediastinum and heart are shifted to the left. The osseous structures are intact.
Congenital lobar emphysema. Lateral view in the same patient.
Congenital left side lobar emphysema.
Review chest X-ray of the child with congenital emphysema of the upper lobe of left lung: pulmonary tissue of upper lobe of left lung is increased lucent, in the lower areas - reduced by compression of the lower lobe, the mediastinum is shifted to the right.
The mediastinum is flat and shifted to the right.
The differential diagnosis is carried out with pneumothorax, cysts, diaphragmatic hernia, hypoplasia and aspiration syndrome.