A Case of Pulmonary Interstitial Emphysema Treated by Percutaneous Catheter Insertion in Extremely Low Birth Weight Infant

Abstract

The pulmonary interstitial emphysema (PIE) is a life-threatening illness in premature infants with mechanical ventilation. While most are managed conservatively, decompression would be necessary. Here, we report the first case of PIE treated by percutaneous catheter insertion in an extremely low birth weight (ELBW) infant in Korea. The patient, born with 660 g in 23+2 weeks of gestation, showed PIE in left lower lung on postnatal day 12. Percutaneous catheter insertion was performed on postnatal day 25. The size of PIE decreased, but didn't disappear completely. On postnatal day 42, we exchanged catheter and inserted additional catheter in pleural space. However, sudden desaturation and pneumothorax occurred on postnatal day 44. We changed catheter in pleural space, and pneumothorax and PIE improved. Finally, we successfully removed catheters, and weaned patient out. As in our case, percutaneous catheter insertion would be a useful option for ELBW infants with PIE.

Keywords: Pulmonary emphysema; catheters, indwelling; extremely low birth weight infant; premature infant.

Fig. 1. Chest radiographic findings. (A) Initial finding of the PIE on day 12. (B) PIE aggravated on day 25. (C) Decreasing size of the PIE on day 30. (D) The size of the PIE increased after stopping the drainage on day 30. (E) Tension pneumothorax on day 45. (F) Improved PIE after decompression on day 45. (G) Removal of both tubes and stopping the drainage on day 56. (H) Endotracheal extubation on day 57. PIE, pulmonary interstitial emphysema.

Fig. 2. CT scan findings. About 3.7×2.9 cm multilobulated cystic mass is noted at left lower lobe.