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LUNG
HELMI LUBIS
R I D W A N M . D A U L AY
WISMAN DALIMUNTHE
R I N I S AV I T R I D A U L AY
Pulmonary hypoplasia (small lung) defined as
lung weight more than 2 SD below the normal for
age (or gestational age)
Chest X ray:
Ribs may appear crowded
No specific treatment
Supportive measures :
Mechanical ventilation
Supplemental oxygen
Prognosis
HELMI LUBIS
R I D W A N M . D A U L AY
WISMAN DALIMUNTHE
R I N I S AV I T R I D A U L AY
Definition: developmental abnormality of the
diaphragm that allow abdominal viscera to enter the
thoracic cavity
Defect:
Most common: posterolateral (Bochladeck) 90% on the left
side, 10% on the right side and 1% bilateral
Retrosternal (Morgagni)
Epidemiology
Incidence:
1 in 2000-4000 lives birth
♂:♀ = 1,5:1
Pathogenesis
USG
MRI
Clinical Manifestation
Majority:
Severe respiratory distress (first hour of life)
Scaphoid abdomen
Apparent dextrocardia (since 90% CHD are on the left)
Decreased breath sound over the involve chest
Delayed presentation:
Vomiting intestinal obstuction, gastric volvulus
Mild respiratory simptom
Occasionally:
Ischemia incarceration of the intestine
Sepsis
Cardiorespiratory collapse
Unrecognized:
Sudden death
Initial Management
Radiology:
CXR lateral: intestine passing the through posterior portion of
diaphragm
USG & Fluoroscopy distuingish true hernia and evantratio
Barrium follow through
CT Scan
Echocardiography pulmonal hypertension
Treatment
Preoperative stabilization:
Intubated
Mechanical ventilation :
Peak inspiratory pressure <25mmHg
Sedation allow coordination of the patient with the ventilator
Operative:
Generally shift from emergency repair to a delayed approach
after stabilization of the infant
Prognosis
HELMI LUBIS
R I D W A N M . D A U L AY
WISMAN DALIMUNTHE
R I N I S AV I T R I D A U L AY
Congenital Lobar Emphysema
Pulmonary emphysema
distention of airspaces with irreversible
disruption of the alveolar septa
Rare condition
Etiology
Respiratory distress
Suggestive of a tension pneymothorax:
Hyperresonance of the affected hemithorax
Chest radiograph
Hyperlucent lobe with features of compression and collapse of
adjacent lung and depression of ipsilateral diaphragm
The mediastinum is deviated, and the contralateral lung may
be collapsed
Occasionally, initial chest radiograph may demonstrate an
opaque lung field then clears and the affected lung becomes
overinflated and hyperlucent
....diagnostic tools
Ventilation-perfusion scanning
› May demonstrate delayed uptake and clearance of isotope
and reduce blood flow in the affected lobe
Bronchoscopy
› Reveal causes of intrinsic obstruction
› Permit the removal of the foreign body or inspissated
secretions
Echocardiogram
› Evaluating the heart and the great vessels
CT scan
› Evaluating the anatomy of the emphysematous lobe
› Size and relations, wheter it has herniated into the
contralateral hemithorax
Differential diagnosis
Endobronchial granulomas
Bronchiale atresia
Bronchogenic cyst
Chylothorax
Treatment