CHEST Guidelines-Diagnostic-Value-of-Quantitative-Chest-CT Sca

Diagnostic-Value-of-Quantitative-Chest-CT Sca

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This case study highlights an 18-year-old woman who presented with acute chest pain, mild shortness of breath, and a spontaneous pneumothorax, leading to the diagnostic investigation for Congenital Lobar Emphysema (CLE). Upon examination and imaging, a large left-side pneumothorax was identified with apical blebs, but she remained hemodynamically stable, so immediate decompression was not essential. Subsequent thoracoscopic surgery and pathology confirmed subpleural blebs and bullous emphysema with fibrosis and inflammation.<br /><br />Further pulmonary function tests suggested mild obstructive lung disease. High-resolution CT scans without contrast supported the diagnosis with findings of decreased lung parenchymal density and increased emphysematous lung in the left upper lobe and the middle lobe. The use of Quantitative Imaging Analysis (QIA) assisted in identifying the extent of emphysema and excluded other potential diagnostics like bronchial atresia or Swyer-James syndrome. CLE often leads to overdistension of affected lobes, presenting with compensatory shift or compression of other lung structures. <br /><br />CLE typically presents in infancy, with an incidence of 1 in 20,000, more common in males, mostly affecting the left upper lobe. It may arise from bronchial obstruction during fetal development, and in many cases, no specific airway pathology is identifiable. Imaging is critical in diagnosis, with QIA showing promising utility in accurate identification of emphysema areas beyond the capability of conventional analysis.<br /><br />Management of CLE diagnosed later in life often involves clinical observation unless severe symptoms or significant pulmonary function obstruction prompts surgical intervention. This case emphasizes the importance of advanced imaging modalities and highlights that while rare, CLE can present atypically as spontaneous pneumothorax well into adulthood. The patient returned to normal activities post-evaluation, illustrating the potential for conservative management in certain CLE cases.

Keywords

Congenital Lobar Emphysema

spontaneous pneumothorax

thoracoscopic surgery

subpleural blebs

emphysema

Quantitative Imaging Analysis

pulmonary function tests

obstructive lung disease

high-resolution CT scans

conservative management