pulmonary interstitial emphysema

Introduction

A collection of gases within connective tissue of peribronchovascular sheaths, interlobular septa & visceral pleura

Etiology

risk factors

• prematurity
• respiratory distress syndrome
• meconium aspiration
• amniotic fluid aspiration
• infection: neonatal sepsis, pneumonia, or both
• low Apgar score or need for positive pressure ventilation during resuscitation at birth
• high peak airway pressures on mechanical ventilation
• incorrect positioning of endotracheal tube in one bronchus

Epidemiology

• infants
• 3% of infants admitted to the neonatal intensive care unit

Clinical manifestations

• hypotension
• dyspnea: difficulty in oxygenation & ventilation

Laboratory

• arterial blood gas

Radiology

• chest X-ray
  • best visualized in the anteroposterior supine projection
• CT scan of the chest can be a helpful if doubt about the diagnosis

Complications

• respiratory insufficiency
• other air leaks
  • pneumomediastinum
  • pneumothorax
  • pneumopericardium
  • pneumoperitoneum
  • subcutaneous emphysema (rare)
  • massive air embolism
  • chronic lung disease of prematurity
  • intraventricular hemorrhage
  • periventricular leukomalacia
  • death

Management

• transfer to neonatal intensive care unit
• intensive respiratory therapy

More general terms

• interstitial lung disease
• neonatal disorder or disease