CTICasesCongenital Lobar Overinflation (Congenital Lobar Emphysema)
Imaging findings
A 61-year-old woman incidentally found to have sharply demarcated hyperlucency and rarefaction confined to the left upper lobe, best appreciated on coronal reformats, without an associated mucus plug or bronchial obstruction and without the patchy multilobar pattern typical of Swyer-James syndrome. Discussion of adjacent vessel caliber noted that vessels on the affected side were only mildly, not severely, attenuated compared with the contralateral lung.
Key takeaways
Sharply marginated, non-patchy hyperinflation confined to a single lobe (classically the left upper lobe) without a demonstrable obstructing lesion favors congenital lobar overinflation (formerly congenital lobar emphysema/hyperinflation) even when discovered incidentally late in life and even when it can be segmental rather than strictly lobar; near-normal vessel caliber in the affected lung was debated as either consistent with a congenital process with preserved alveolar development or as an argument favoring an acquired process such as Swyer-James syndrome, illustrating that vessel attenuation is a useful but imperfect discriminator.
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