Early sonographic manifestation of fetal congenital lobar emphysema

Advanced fetal sonographic equipment has contributed to the increase in prenatal diagnosis of congenital thoracic malformations. Among these anomalies is congenital lobar emphysema (CLE), a rare congenital anomaly characterized by over distention and overexpansion of the involved fetal pulmonary lobe. Several studies addressed the prenatal diagnosis of CLE in mid second or early third trimester. The early prenatal diagnosis and the outcome of a case of CLE are reported in this study.     

Congenital lobar emphysema--the disappearing chest mass: antenatal ultrasound appearance.

Prenatal diagnosis of congenital lobar emphysema is rarely reported in the literature. This case presents a fetus with an echogenic lung diagnosed at 18 weeks' gestation, that resolved completely during the pregnancy. This case is unique in that sonographic increased echogenicity was first noted at 18 weeks' gestation and had disappeared by 29 weeks' gestation. The diagnosis was made in the postnatal period as a result of follow up of the prenatal findings. This case reinforces the importance of continuing postnatal investigations of prenatal sonographic abnormalities even when they appear to have disappeared. A discussion of the causes of congenital lobar emphysema is presented.     

Prenatal diagnosis of lobar holoprosencephaly.

Lobar holoprosencephaly was identified with sonography in 12 fetuses between 21 and 35 weeks' gestation. A confident diagnosis was made in each case by a mid-coronal view of the brain demonstrating absence of the cavum septum pellucidum with fusion and squaring of the frontal horns. The only associated anomaly was Dandy-Walker malformation that occurred in three cases. All fetuses had mild to severe ventriculomegaly. Five pregnancies were terminated; there was one spontaneous abortion and six fetuses were delivered at term. A ventriculo-peritoneal shunt was implanted in four. Follow-up was available for five and revealed severe mental retardation in each case. Lobar holoprosencephaly is amenable to prenatal ultrasound diagnosis, although a differentiation with other cerebral malformations may be difficult at times. The outcome of affected infants remains uncertain, but neurological impairment occurs frequently.     

Ecstasy induced retropharyngeal emphysema.

This is the first reported case of isolated retropharyngeal emphysema caused by ingestion of the amphetamine derivatives "Ecstasy" and "Speed". The same complication has been reported with marihuana, cocaine, and heroin abuse. The condition resolved spontaneously and this seems to be the experience of others who have reported cases of cervical emphysema and pneumomediastinum associated with substance abuse. Because of the self limiting nature of this condition, extensive investigations may not be necessary but hospital admission and close observation are still mandatory.     

Chronic lobar consolidation

Lobar consolidation in a chest X-ray is often thought to be due to infection. We present the problem of a 66-year-old female with low grade non-Hodgkin's lymphoma of the mucosa associated lymphoid tissue (MALT) type who had features of lobar consolidation that persisted for years. The different causes, both infectious and non-infectious, of this kind of presentation are discussed.     

Mediastinal and subcutaneous emphysema in labor.

The recent world literature on mediastinal emphysema has been reviewed and two cases added. This condition is relatively benign, and the supportive treatment is discussed. Subsequent pregnancies have been uncomplicated.