Cystic disease of the lung in the newborn treated by pneumonectomy.

Congenital cystic disease of the lung is an uncommon condition which may remain asymptomatic for long periods or may, at any time, become potentially lethal either as a result of infection or of increasing tension in the cysts. Infection is a constant danger whenever a cavity communicates with the bronchial tree and is responsible for the development of symptoms in a considerable number of cases. Ravitch and Hardy (1949) found evidence of infection in every one of 12 lung cysts excised in childhood. That infection may arise at a very early age is shown by the third case of Swan and Aragon (1954) in which a large air-containing cyst, shown radiologically at the age of 6 days, had been transformed into a tense abscess two weeks later. In early infancy, however, acute symptoms are more often produced by rising tension in the cysts and it seems that, if this complication is to develop during childhood, it nearly always does so in the first year, and, indeed, in the majority of cases, during the first few weeks of life. The early diagnosis of tension cysts has assumed increasing importance since it has been realized that surgical treatment can retrieve or prevent the desperate situation which may arise when a valvular obstruction in the bronchus causes the cysts to balloon thus increasing compression of the normal lung tissue. The first successful resection for this condition in a young infant was reported by Fischer, Tropea and Bailey (1943). Swan and Aragon (1954) reported three successful resections for congenital cystic disease of the lung and quote references to 15 other resections in infancy after the original case of Fischer et al. In 15 of these 19 cases symptoms were due to increasing tension in the cysts. In addition we have found reports in the British and American literature of a further nine cases of tension cysts in infancy treated by resection (Walker, Taggart and Staton, 1948; Strode, Case 2, 1949; Dugan and Samson, Cases 1 and 4, 1950; Hill, 1951; Whitesell and White, 1952; Belcher and Siddons, three cases, 1954). Of this total of 24 cases, 21 were subjected to lobectomy and three to pneumonectomy with only one post-operative death (Strode, 1949) and a satisfactory functional result in all other