Lobar emphysema complicating hyaline membrane disease

A pre-term infant with severe hyaline membrane disease (HMD), requiring intubation and mechanical ventilation, who developed bronchopulmonary dysplasia (BPD), which was followed by lobar emphysema in the right lower lobe is presented. Surgical removal of the right lower lobe led to prompt improvement in the oxygen requirements and subsequent recovery of the infant's respiratory distress. Pathology revealed marked stenosis of the right lower lobe bronchus and air-trapping, without destruction of alveoli. The lobar bronchus contained adequate cartilage, but deficient muscle at the site of stenosis. It seems likely that this bronchial stenosis, and resultant lobar emphysema was not congenital, but was a complication of HMD, BPD or therapy.