Congenital Lobar Overinflation Presenting with Recurrent Pneumothoraces

Congenital lobar overinflation (CLO) is a rare neonatal developmental anomaly. We present the case of a newborn boy who was born as a first twin at the 26th gestation week, and transferred to the department of pediatric intensive care due to respiratory distress and prematurity. Recurrent pneumothoraces were observed, and the chest drain was inserted. However, saturation was unsatisfactory although he was intubated and ventilated by synchronized intermittent-mandatory ventilation (SIMV). The chest radiographs showed hyperinflation of the right middle lobe, with mediastinal shift to the left, and atelectasis of the remaining lobes. That caused ventilation and perfusion mismatch and hypoxia, due to a decrease in ventilated lung tissue. When high-frequency ventilation was instituted, he stabilized. Computed tomography (CT) of the chest revealed the cause and the diagnosis of CLO was made. A high index of suspicion is needed when clinical and radiological findings are present in a newborn with respiratory distress and recurrent pneumothoraces to ensure prompt diagnosis and optimal, timely treatment.