Development of Localized Pulmonary Interstitial Emphysema in a Late Preterm Infant without Mechanical Ventilation

Abstract

Pulmonary interstitial emphysema (PIE) is not an uncommon finding in premature infants with respiratory distress who need respiratory support by mechanical ventilation. PIE has been reported in a few cases of neonates in whom either no treatment other than room air was given or they were given continuous positive end-expiratory pressure (CPAP) support. We present a case of a premature neonate who presented with respiratory distress, in whom PIE and spontaneous pneumothorax (PTX) developed while on CPAP therapy only. The patient was treated conservatively with subsequent resolution of the radiological findings and clinical improvement. No surgical intervention was required. It is important to know that PIE may develop independently of mechanical ventilation. We would like to add this case to the literature and describe the pertinent plain film and computed tomography (CT) findings of this entity, the possible mechanism of development, and the differential diagnosis. A review of the literature is also provided.

Figure 1

Frontal view of the chest demonstrates mild hyperinflation and mild diffuse air-space disease.

Figure 2

Frontal view of the chest demonstrates the development of multiple air-containing structures within the right lung and pneumomediastinum.

Figure 3

Left lateral decubitus view shows small pneumothorax (arrow) and enlargement of air-containing structures within the right lung (arrowhead).

Figure 4

Representative slice from CT scan shows loculated pneumomediastinum (arrow) and multiple branching lucencies in a perivascular distribution, compatible with PIE.

Figure 5

Frontal view of the chest shows complete resolution of PIE, pneumothorax, and pneumomediastinum.