A 4-month-old male infant was admitted to the hospital because of recurrent respiratory infections that started early in the neonatal period. He had been admitted to hospitals at ages 6 days, 50 days, and 3 months for treatment of respiratory infections. His physical examination revealed respiratory distress with decreased breath sounds in the left hemithorax. The cardiac examination results were normal. A chest radiograph was obtained (Fig 1). Culture of tracheal aspirate yielded Streptococcus pneumoniae. The patient was treated with antibiotics and chest physiotherapy. Despite clinical improvement, there was no alteration in the chest radiographic findings. A computed tomographic scan of the chest (Fig 2), bronchoscopy, and bronchography (Fig 3) were performed. Bronchoscopy showed no inhaled foreign body.
Denouement and Discussion
Hypoplastic Left Upper Lobe
At thoracotomy, the patient was found to have a markedly hypoplastic left upper lobe that was firm, consolidated, and had fibrinous pleural adhesions. The right lung was hyperexpanded. While dissection was carried out for a left upper lobectomy, the patient developed severe bradycardia and hypotension from reflex vagai stimulation. He was resuscitated and recovered, but soon developed another such episode. The procedure was postponed and the infant was admitted to the intensive care unit. Seven days later, he experienced a cardiac arrest and