Anatomic Pulmonary Lobectomy via Video-Assisted Thoracoscopic Surgery in an Adult Patient With Congenital Lobar...

Congenital lobar emphysema (CLE) is a congenital lung malformation characterized by progressive hyperinflation of a pulmonary lobe. We report the case of a 23-year-old male, an active-duty military service member with a history of recurrent pneumonias and lung abscesses since childhood, who presented with a new infectious episode. A chest computed tomography scan revealed an abscess in the right upper lobe, together with air trapping and overdistension of both the apical segment of the right upper lobe and the adjacent right middle lobe, raising suspicion for a congenital lung malformation. After achieving antibiotic control of the acute infection, a delayed right upper lobectomy was performed via video-assisted thoracoscopic surgery (VATS). The histopathological study confirmed focal bronchomalacia as the underlying finding. This case illustrates an atypical presentation of CLE in a young adult with severe infectious complications. A delayed VATS lobectomy, performed after control of the infectious process, achieved a good functional outcome. The postoperative course included a prolonged air leak that was managed conservatively on an outpatient basis and resolved without further morbidity. This case underscores the importance of a multidisciplinary approach and of individualized surgical planning in this rare disease.