Fluid-filled lung due to airway obstruction in the newborn

Airway obstruction classically leads to either atelectasis or emphysema. Obstructions developing in utero might be expected to cause different phenomena, however, since fetal lungs contain fluid, not air. The two newborn infants presented here demonstrate the pathophysiologic effects of total intrauterine bronchial occlusion and the consequent retention of pulmonary fluid. One infant had extrinsic occlusion of the left main-stem bronchus by a small bronchogenic cyst. The other had atresia of the bronchus leading to his accessory left upper lobe. In each the obstructed pulmonary tissue was expanded and filled with fluid. In neither case did the clinical and roentgenographic findings suggest airway obstruction pre-operatively. The contrast with the atelectatic and emphysematous manifestations of later-life airway obstruction is marked. Those who care for newborn infants must be aware that a chest mass or opaque lung by x-ray or large but fluid-filled pulmonary tissue upon thoracotomy may in fact represent remediable airway obstruction.