Pulmonary interstitial emphysema

Case contributed by Dr Hisham Alwakkaa

Presentation

Premature newborn (born at 33 weeks), on conventional mechanical ventilation for respiratory distress syndrome.

Patient Data

Age: 2 days
Gender: Male
X-ray

Stable life-support hardware.

Left moderate-sized pneumothorax, with collapsing of the underlying lung.

Mild hyper-expansion of the right lung, associated with diffuse haziness and branching linear radiolucencies throughout the entire lung.

Two subsequent chest radiographs were taken approximately after 8 and 20 hours from the initial image and switching from conventional mechanical ventilation to high-frequency jet ventilation.

X-ray

followup images

On the 8 hours radiograph, there is interval placement of chest tube on the left side with nearly complete resolution of the pneumothorax. Diffuse branching radiolucencies now evident, after the re-expansion of the left lung, representing pulmonary interstitial emphysema, which is the underlying cause for the previously seen pneumothorax. In addition, the right lung is less expanded with dramatic decrease in the branching radiolucencies through the right lung. Bilateral patchy hazy opacification related to respiratory stress syndrome is also evident.

X-ray

On the 20 hours radiograph, both lungs are normally inflated, and there is near complete resolution of the pulmonary interstitial emphysema. Bilateral patchy hazy opacification related to respiratory distress syndrome is again identified.

Case Discussion

This is a case is a classic example to show pulmonary interstitial emphysema (PIE) complicated by pneumothorax. In addition, it demonstrates the dramatic improvement that can happen after switching from conventional mechanical ventilation to high-frequency ventilation as a treatment for PIE.

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Case information

rID: 58838
Published: 8th Mar 2018
Last edited: 18th May 2018
Systems: Chest, Paediatrics
Inclusion in quiz mode: Included
Institution: Women and children Hospital of Buffalo

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