PMC8326181_01
(A) Initial anterior-posterior chest radiograph at presentation showing very large pneumothorax on the left. (B) Computerized tomographic axial image revealing emphysematous changes in the left upper lobe. In contrast, the pulmonary parenchyma of the right lung is normal in appearance.
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Chest x-ray (CXR) at presentation showed a very large left side pneumothorax (Fig. 1A).
(A) Gross specimen of the left upper lobe status post lobectomy. The yellow arrows delineate the only remaining healthy lung tissue. The remainder of the specimen is abnormal and representative of gross anatomy consistent with chronic emphysematous disease. (B) Hematoxylin & eosin stain 10 x magnification demonstrating moderate emphysematous changes with inflammatory neutrophilia (pneumonitis) noted in lung tissue. (C) Hematoxylin & eosin stain at 45 x magnification showing advanced emphysematous changes of pulmonary parenchyma in congenital lobar emphysema.
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The diseased lobe was resected (Fig. 2A) and submitted to pathology. Macroscopic and microscopic tissue analyses were consistent with chronic emphysematous changes with patchy chronic organizing pneumonitis and foci of compression atelectasis with no evidence of malignancy (Fig. 2B and C).
(A) Post chest tube CXR showing persistent left apical pneumothorax. Green arrows indicating pleural demarcation. (B) Post VATS and lobectomy CXR showing reduced left lung volume with left side chest tube in place and resolution of pneumothorax.
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However, a follow up CXR done after chest tube insertion showed persistence of pneumothorax. (Fig. 3) Computed tomography (CT) of the chest showed emphysematous changes in the left upper lobe (Fig. 1B).