Recurrent pneumonia unmasks congenital lobar emphysema in a 2-month-old infant: Radiological insights from a rare ICU case report

Congenital lobar emphysema (CLE) is a rare pulmonary malformation characterized by hyperinflation of 1 or more lobes due to bronchial cartilage or connective tissue abnormalities. Although typically presenting in neonates and young infants with respiratory distress, CLE may mimic more common conditions such as pneumothorax or recurrent pneumonia leading to diagnostic delays or inappropriate management. We report the case of a 2-month-old female infant admitted for recurrent respiratory infections and acute respiratory distress. The initial chest radiograph suggested a pneumothorax; however, chest CT demonstrated a giant emphysematous bulla involving the right upper lobe, causing significant mediastinal compression, consistent with CLE. The patient underwent right upper lobectomy, and histopathology confirmed emphysematous changes with chronic nonspecific inflammation and hemorrhagic remodeling. Postoperative evolution was favorable. This case illustrates the diagnostic challenges associated with CLE, particularly its potential to mimic pneumothorax and prompt inappropriate invasive procedures. Radiological evaluation-especially CT imaging-plays a pivotal role in establishing a definitive diagnosis and guiding appropriate management. Early recognition of CLE is essential to avoid misdiagnosis and ensure optimal treatment. This case underscores the importance of integrating clinical and imaging findings when evaluating infants with recurrent or unexplained respiratory symptoms.