This unique case demonstrates that pulmonary hypertension can be seen in the setting of PIG without associated cardiac anomalies, and persists despite treatment in an otherwise self-limited condition.

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Pulmonary interstitial emphysema (PIE) is most commonly seen in the setting of preterm, low birth weight neonates with lung disease. It exists on a spectrum with pneumomediastinum and pneumothorax and is often a transient phenomenon. This condition has been rarely reported in neonates while only on nasal continuous positive airway pressure (CPAP) without mechanical ventilation, but only as a localized presentation. We present a case of a late preterm neonate with diffuse PIE complicated by bilateral pneumothoraces, requiring chest tubes, with congenital thyroid aplasia as well.

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