VATS for Congenital Lobar Emphysema With Osseous Metaplasia

This video demonstrates a video-assisted thoracoscopic resection of a congenital lobar emphysema in a young woman with spontaneous pneumothorax. Congenital lobar emphysema occurs when there is a developmental ball-valve obstruction in the bronchial tree. This is usually related to bronchial malformation and most commonly affects the left upper lobe.

Small osseous formations were observed in the resected lobe. Pulmonary osseous metaplasia (OM) is a poorly understood phenomenon related to chronic inflammation and possibly related to fibroblast transformation triggered by TGF-β. Most cases of pulmonary OM are reported in conjunction with usual interstitial pneumonia, but it has also been described to a lesser extent in other lung conditions. A diffuse (dendriform) bilateral form of the disease has also been described.

Suggested reading

1. Schwartz MZ, Ramachandran P. Congenital malformations of the lung and mediastinum--a quarter century of experience from a single institution. J Pediatr Surg. 1997;32(1):44-47.
2. Poon C. Pulmonary Osseous Metaplasia Associated With UI. Chest. 2011;140(4)(suppl):134A.
3. Hashemi N, Gill N, Balasubramanian V. Bony Metaplasia in Interstitial Lung Disease. Chest. 2011;140(4)(suppl):119A.
4. Konoglou M, Zarogoulidis P, Baliaka A, et al. Lung ossification: an orphan disease. J Thorac Dis. 2013;5(1):101-104.

This case was submitted as a poster for the Gulf Thoracic 2017 Meeting in Dubai, UAE.