Lobar Emphysema 1 (Differential Diagnosis RDS)

Repeated chest radiographs in a newborn with progressive respiratory distress syndrome. Left picture: 3rd day of life. The upper right hemithorax is larger than its left counterpart. Notice the large intervals between the ribs. Center picture: 10th day of life. The difference between left and right becomes more pronounced; an absent lung structure in the right upper and middle hemithorax is recognizable. Right picture: 21st day of life: There is no heart shadow in the right hemithorax; an increase of the zone with absent lung structure is obvious and partially so in the left hemithorax, too. In contrast to the sudden onset of respiratory distress syndrome in most patients with congenital diaphragmatic hernia, respiratory distress syndrome or the signs of the respiratory system appear slowly during the neonatal period in many of the pathologies with a valve mechanism. In this case the pathology is a lobar emphysema of the right upper lobe. The lobe is progressively overinflated due to a valve mechanism which explains the radiological findings: On the 3rd day the opacity of the lower right hemithorax (corresponding to a compression and increasing atelectasis of the right middle and lower lobe) should have raised the suspicion of a lobar emphysema of the right upper lobe. By the 10th day this diagnosis is obvious. Missing lung structures of the right upper and middle hemithorax correspond to an overinflated upper right lobe. By the 21st day the latter has herniated to the contralateral side and is displacing the heart to the left.