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),