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Joseph Junewick, MD FACR
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Pulmonary Interstitial Emphysema

Case Detail

Anatomy: Chest
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: CR
Activities:
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History

4 day old former 26 week premature infant.


Case Images


Diagnosis

Pulmonary Interstitial Emphsema

Findings

CR – Branching interstitial lucencies in right upper lobe and left lung.

Discussion

Pulmonary interstitial emphysema occurs when air ruptures from the alveoli and small airways into the perivascular tissue of the lung. The process often occurs in conjunction with respiratory distress syndrome but can be seen with meconium aspiration syndrome, amniotic fluid aspiration, and infection. Positive pressure ventilation and reduced lung compliance are predisposing factors. Pulmonary interstitial emphysema has been rarely reported in the absence of mechanical ventilation or continuous positive airway pressure.

Interstitial and perivascular fluid that is often present in the first few days of life may obstruct the movement of gas from ruptured alveoli or airways to the mediastinum, causing an increase of pulmonary interstitial emphysema. Increased amount of pulmonary connective tissue in the immature lung may also act to trap air. Air in the interstitium contribute to adjacent atelectasis which will necessitate increase in ventilatory pressure and subsequent increase in interstitial empysema.

Pulmonary interstitial emphysema compresses adjacent functional lung tissue and vascular structures and hinders both ventilation and pulmonary blood flow, thus impeding oxygenation, ventilation, and blood pressure. Pulmonary interstitial emphysema can completely regress or decompress into adjacent spaces, causing pneumomediastinum, pneumothorax, pneumopericardium, pneumoperitoneum, or subcutaneous emphysema.

Reference

Bhatt A. Pulmonary Interstitial Emphysema. eMedicine 2011.



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