Successful salvage of a long-standing collapsed lung by bronchoplasty in three children

The authors report successful salvage of the ipsilateral lung by a bronchoplastic procedure in 3 patients with a long-standing, totally collapsed lung.

The 3 patients were 1, 5, and 6 years of age, and the left lung had been collapsed totally for periods of 13 months to 5 years. The origin of atelectasis was congenital in 2 patients and traumatic in one patient. Bronchoscopy showed complete obstruction of the left main bronchus. In each patient, the left lung was small and appeared as a liverlike organ. Entire length of the main bronchus was resected. The left lung was not aerated in spite of aggressive bagging through an endotracheal tube inserted into the distal bronchial stump. The bifurcation of the upper and lower segmental bronchi was anastomosed to the trachea by interrupted sutures. Histology of the resected bronchus in the cases of congenital origin showed bronchial rings represented by islands of immature cartilage.

Chest x-ray showed complete aeration of the left lung at 3, 4, and 5 months, respectively, after surgery in the 3 children. Bronchoscopy disclosed a well-reconstructed airway in all patients. Two of the 3 patients have been free from respiratory distress during a 3- to 4-year follow-up. The latest patient to have this surgery is undergoing home ventilation because of chronic lung disease.

A long-standing collapsed lung in children may reexpand if bronchial continuity is restored. Insufficient inflation of the lung at surgery is not an indication for pneumonectomy. When at all possible, a child's lung should be preserved.