Neonatal tension pulmonary interstitial emphysema in bronchopulmonary dysplasia: treatment with lateral decubitus positioning.

Schwartz, Adam; Graham, Cole Blease

doi:10.1148/radiology.161.2.3763899

Cited by 23 publications

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“…However, development of PIE may be a cause of respiratory deterioration, resulting in a life-threatening condition. Conservative treatments for PIE include HFO ventilation, lateral decubitus positioning [4], and systemic steroid administration [5]. For cases of PIE refractory to these treatments, selective bronchial intubation [6,7], balloon occlusion of the ipsilateral bronchus [8,9], and surgical resection of the affected lobes have been reported to be effective treatment strategies [10].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

et al. 2012

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IntroductionPulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old) boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter.Case presentationThe baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition.ConclusionsTherapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

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Section: Discussionmentioning

confidence: 99%

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

et al. 2012

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“…The age of onset of PIE ranged from day 1 to day 24 and was not related to the primary respiratory diagnosis, suggesting that the development of PIE is related to both the type of lung disease and barotrauma -a consequence of treatment with mechanical ventilation [3,[6][7][8][9][10]11]. As the lungs' response to barotrau-Fitzgerald/Willis/Usher/Outerbridge/ Davis Table 3.…”

Section: Discussionmentioning

confidence: 99%

“…PIE is diagnosed radiologically [4,5] and characterised by the presence of linear radiolucencies reflecting an accumulation of interstitial air. This may result in impaired pulmonary blood flow, decreased lung compliance and in-creased airway resistance [6,7]. The mortality of infants with PIE that were managed with conventional mechanical ventilation in the pre-surfactant 1980s was reported to be as high as 67% [8] and 80% [6].…”

Section: Introductionmentioning

confidence: 99%

“…In the last decade, three successful, nonoperative treatments for PIE have been reported [3,7,10]. High-frequency jet ventilation (HFJV) lowered mean airway pressures (MAP) and reduced mortality in surfactanttreated infants who developed early-onset PIE (in the 1st week of life) [3].…”

Section: Introductionmentioning

confidence: 99%

“…High-frequency jet ventilation (HFJV) lowered mean airway pressures (MAP) and reduced mortality in surfactanttreated infants who developed early-onset PIE (in the 1st week of life) [3]. Secondly, lateral decubitus positioning for 3 days was associated with radiological resolution of 'tension PIE' in 19/21 milder cases whilst their 'respiratory status either improved or remained stable' [7]. Thirdly and most interestingly, Mohsini et al [10] reported that systemic dexamethasone (7-to 12-day course with differing doses) resulted in decompression of acquired lobar emphysema complicating late-onset PIE (after the 1st week) in 3 low birthweight infants aged 2, 4 and 8 weeks.…”

Section: Introductionmentioning

confidence: 99%

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Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

Fitzgerald

Willis²,

Usher³

et al. 1997

Neonatology

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The efficacy of a 3-day course of dexamethasone (0.5 mg/kg/day) in 10 preterm infants (≤30 weeks gestation) with pulmonary interstitial emphysema (PIE) was studied in a retrospective case review. PIE was diagnosed at a median age of 7.5 days and treatment with dexamethasone began at 8.5 days. Seven of the 10 subjects had at least 2 days of conservative treatment (lowered mean airway pressure) preceding dexamethasone during which the mean airway pressure (MAP), oxygenation index (OI) and mechanical ventilation index (MVI) were not significantly different although within 3 days of dexamethasone each variable improved significantly (p < 0.05). Similarly, for all 10 infants, OI and MAP were significantly lower at 3 and 7 days from baseline (p < 0.005). By day 7, FiO₂ (p = 0.022) and MVI (p = 0.011) were significantly lower and PIE had resolved on chest X-ray in 7/9 (78%) and improved in the remaining 2/9 (22%). Nine of the 10 infants survived to term. Three days of dexamethasone was associated with significant clinical improvement in most of these infants. The mechanism may relate to reduced airway oedema and inflammation and reduced airway obstruction.

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Management of primary liver sarcomas

Weitz

Klimstra

Cymes

et al. 2007

Cancer

175

134

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BACKGROUNDPrimary hepatic sarcoma is a rare entity. The objectives of the study were to define treatment and long‐term outcome and to identify prognostic factors.METHODSBetween January 1981 and December 2004, 30 patients with primary sarcoma of the liver and 5 patients with primary carcinosarcoma of the liver were treated. Patient demographics, tumor characteristics, treatment, and actuarial survival were analyzed.RESULTSOf the 30 patients with primary hepatic sarcoma (10 epithelioid hemangioendothelioma, 5 embryonal sarcoma, 5 angiosarcoma, 3 solitary fibrous tumor, and 7 other types), 11 underwent R0‐resection and had a 5‐year disease‐specific survival of 64%. Of these 11 patients, 4 had low‐grade sarcoma and have not developed tumor recurrence. In the group of 7 patients with high‐grade sarcomas who underwent R0‐resection, both patients with angiosarcoma died within 11 months, whereas the 5 patients with embryonal sarcoma had a 5‐year disease‐free and disease‐specific survival of 80%. Six of the 10 patients with an epithelioid hemangioendothelioma were managed without surgery, as they had diffuse, slowly progressing, or stable lesions; these patients had a 5‐year disease‐specific survival of 67%. Of the remaining 13 patients in whom R0‐resection was not performed, there were no 3‐year survivors. The prognosis for patients with primary carcinosarcoma of the liver was poor, with all but 1 patient dying within a year and no 3‐year survivors.CONCLUSIONSThe outcome of patients with primary hepatic sarcoma depends primarily on tumor histology and the ability to achieve complete tumor resection. Improvements in outcome will require the development of more effective systemic therapies. Cancer 2007. © 2007 American Cancer Society.

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Neonatal tension pulmonary interstitial emphysema in bronchopulmonary dysplasia: treatment with lateral decubitus positioning.

Cited by 23 publications

References 0 publications

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

Dexamethasone for Pulmonary Interstitial Emphysema in Preterm Infants

Management of primary liver sarcomas

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