OBJECTIVE: To highlight the importance of CCLDs as the etiology of respiratory distress in children with the chest x-ray (CXR) feature resembling a pneumothorax especially in a resource-limited setting where advance imaging modality is not widely available to avoid harmful consequences of chest tube placement.
CASE REPORT: An 18-days-old male newborn presented with respiratory distress along with fever, cough and low intake since 2 days. He appeared to be hypoactive with signs of increased breathing effort. He had a slightly reduced left breath sound with the presence of crackles on both lung fields. He was initially diagnosed with late-onset sepsis and neonatal pneumonia, and treated accordingly. On the fourth day of admission, the respiratory distress worsen and the CXR showed a hyperlucent left lung with contralateral mediastinal shift. Tension pneumothorax was suspected and a thoracostomy tube was inserted. Air was evacuated along with unexpected yellowish serous fluid. The respiratory distress was not improved and got worsen subsequently. He was deceased later due to a worsening respiratory distress and unresolved sepsis. The diagnosis of congenital pulmonary airway malformation dd/ congenital lobar emphysema of the left lung was later be suspected.
DISCUSSION: CCLDs are commonly present as respiratory distress in infant with a CXR feature that could be mistaken as a pneumothorax case. Chest CT has a definite role in confirming the diagnosis, but not commonly available in low-resourced areas. Chest tube placement in CCLDs cases could delay the diagnosis and causing various complications, thus harmful to be used. 
CONCLUSION: The diagnosis of CCLDs should always be considered in children with a respiratory distress with a CXR feature that resembling a pneumothorax. In the setting where chest CT is not available and chest tube insertion is unavoidable, CCLDs should be considered especially when the respiratory distress is not improving or even worsen after its placement.