CT Findings and Temporal Course of Persistent Pulmonary Interstitial Emphysema in Neonates: A Multiinstitutional Study

Abstract

Our study found that 82% of patients with persistent pulmonary interstitial emphysema had characteristic CT findings (central lines and dots surrounded by radiolucency). Although most patients in this series eventually underwent surgical resection, initial treatment can be conservative. The decision to perform surgery may have reflected the local medical culture.

Localized persistent interstitial pulmonary emphysema presenting as a spontaneous tension pneumothorax in a full term infant

“…In particular, characteristic CT findings of central lines and dots surrounded by areas of radiolucency, although not present in this case, have been reported in one study to be present in 82% of those with persistent PIPE, suggesting that the use of CT versus simple CXR may be more advisable in cases where the diagnosis is unknown [13]. The treatment of congenital lung lesions is generally surgical, however, the management of PIPE is most often initially supportive, with repositioning, inhaled oxygen therapy, and frequent monitoring being the mainstays of therapy.…”

Pulmonary interstitial emphysema: a case report and review of the literature

“…A peculiar type of focal PIE manifests as single or multiple cysts with regular borders called pseudocysts, most frequently found in the right para-hilar region (3) . The tomographic pattern described as "lines and dots" intermingled with large gaseous inclusions is typical, representing peribronchovascular bundles compressed by the air-filled interstitium , with sensitivity of up to 82% in some studies (1) . The differential diagnosis is made with conditions which present with "cystic chest" in the neonate and include cystic adenomatoid malformation, congenital lobar emphysema, diaphragmatic hernia, pneumatoceles, bronchogenic cyst (in cases of isolated pseudocyst) and aspiration pneumonia (1,2,3,7) .…”

“…Still poorly known by non-specialist radiologists, pulmonary interstitial emphysema (PIE) represents an uncommon acute complication in preterm, low-weight newborns who develop respiratory distress syndrome requiring mechanical ventilation (although such characteristics are not essential to define the condition) (1,2) . The genesis of such a condition is attributed to the effects of the high pressure levels provided by the mechanical ventilation on a poorly characterized at left.…”

A cystic pulmonary lesion in an infant

“…1 PPIE is a rare condition typically associated with mechanical ventilation of preterm infants, but also seen in term and non-ventilated infants. 1,2 The differential diagnosis of PPIE is broad, including congenital cystic lung lesions, such as congenital cystic adenomatoid malformation, lobar emphysema and bronchogenic cysts. 2 CT scan is the diagnostic tool of choice to diagnose PPIE, with a characteristic line-and-dot pattern, attributed to gas in the pulmonary interstitial space surrounding bronchovascular bundles that appear as linear or punctuate soft-tissue densities within the cystic radiolucencies.…”

“…2 CT scan is the diagnostic tool of choice to diagnose PPIE, with a characteristic line-and-dot pattern, attributed to gas in the pulmonary interstitial space surrounding bronchovascular bundles that appear as linear or punctuate soft-tissue densities within the cystic radiolucencies. 1 The management of PPIE is either surgical or conservative, depending on the severity of respiratory symptoms. Spontaneous resolution of both localized and diffuse PPIE has been reported.…”