0:00

So this was a newborn infant who had respiratory distress

0:04

and concern for a lung lesion prenatally on a

0:07

fetal ultrasound.

0:09

Um, so this patient has an enteric tube

0:11

with the tip projecting over the gastric body,

0:13

so that looks appropriate.

0:14

Um, this one, it's hard to really see much

0:17

of anything abnormal except that both

0:20

of these lung volumes are pretty low.

0:22

And so we should have diffuse haziness related

0:25

to low lung volumes bilaterally.

0:28

But in this left lower lung zone,

0:29

we have paradoxically some hyper lucency.

0:32

So there is some iteration

0:34

of this left lower lung zone compared

0:36

to the rest of the lungs.

0:37

Um, I would, I would have a hard time

0:41

prospectively calling this concerning

0:43

for a congenital lung lesion without knowing that

0:46

that was the location of the lung lesion, um, prenatally.

0:50

So this would be a patient where we would again,

0:52

recommend CT and geography for, uh, lesion delineation prior

0:57

to any sort of in intervention in this patient.

1:01

So that patient went on to, uh, CT

1:03

and geography, uh, about a day later.

1:06

And we can see that, um,

1:09

there is a dentistry artifact related

1:11

to contrast administration in the,

1:13

the right upper arm vasculature.

1:16

And in the SVC we have some crazy dense artifact from

1:18

that very dense contrast bolus.

1:20

But the good news is we can still see the pertinent finding

1:23

of hyper lucency of this left part of this left lower lobe.

1:28

So a little bit of the inferior aspect is overinflated.

1:31

We have some adjacent ectasis

1:33

and then this superior segment left lower lobe

1:36

also has some overinflation.

1:38

So this is pretty, uh, typical for a, um,

1:41

neonatal presentation of bronchial atresia

1:44

or it's on the spectrum of congenital lobar overinflation.

1:48

So, um, we don't really see a plugged mucus

1:51

airway in this patient.

1:52

If we, if you pay clo,

1:54

keep your eye on these left lower lobe airways.

1:56

As I scroll up

1:58

and down, um,

1:59

I don't really see a discreetly plugged

2:02

airway full of mucus.

2:03

It just looks like, um, that entire

2:06

or part rather of that left lower lobe is overinflated.

2:09

So this is the bronch atresia

2:11

or congenital lobar over inflation spectrum of, um,

2:16

of a bronchial atresia slash congenital

2:18

lobar over inflation.

2:20

And again, when we have one lung lesion, we have

2:22

to pay close attention to the rest of the lungs

2:24

to make sure we don't have any other abnormalities

2:26

and this patient looks otherwise pretty normal.

2:29

Normal thymus, normal heart size.

2:31

I don't see any other lung lesions aside from

2:33

that left lower lobe.