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pulmonary interstitial emphysema
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
General
interstitial lung disease; diffuse parenchymal lung disease (DPLS, ILD)
neonatal disorder or disease
References
- Bhatt AJ and Rosenkrantz T
eMedicine: Pulmonary Interstitial Emphysema
http://emedicine.medscape.com/article/976801-overview