Figure 4 Axial view HRCT lung image conforming the presence of
congenital lobar emphysema of right middle lobe.
(Image Credits: Dr. Viral B. Patel)
Right middle lobe resection was performed at 8 months and 9 days of age.
The infant was placed in the left lateral position, and the chest cavity
was entered through the right 4th intercostal space. Dissection was done
using the Reverse Chamberlain Method from the periphery toward the hilum
all around the fissure.The right middle lobe vein was identified and
ligated proximally, and its branches were tied individually. The right
middle lobe artery entering the right middle lobe was identified, and
its branches were isolated. Hemostasis was achieved by controlling the
brisk nature of bleeding using electro-cautery. A bronchial clamp was
applied after the right middle lobe bronchus was slung by the rubber
tubes. The right middle lobe bronchus was divided proximal to the
bronchial clamp. Single-lung anesthesia was commenced. The divided
bronchial stump was closed with multiple interrupted vertical mattress
5/0 polypropylene sutures. The stump’s integrity was checked underwater
with sustained ventilation. A minor leak was noted from the lung
parenchymal surface, and no leak was noted from the bronchial stump. The
right upper lobe and right lower lobe surfaces were sutured together
with two interrupted polypropylene pledgetted sutures. The specimen was
sent for histopathological examination (Figure 5, a and b),