Spontaneous resolution of diffuse persistent pulmonary interstitial emphysema

Abstract

Persistent pulmonary interstitial emphysema (PPIE) is a rare condition that occurs in both preterm and term infants. It is thought to arise from a disruption of the basement membrane of the alveolar wall allowing air entry into the interstitial space. The characteristic CT scan appearance of PPIE can be used to differentiate it from other congenital cystic lesions that may present similarly. Although conservative management is accepted as the initial form of management in most cases, a review of the published literature found that a significant proportion of localized PPIE cases eventually require surgical resection. This case illustrates that extensive bilateral PPIE associated with a persistent pneumomediastinum can resolve spontaneously thus demonstrating that conservative management without surgical intervention may be appropriate for some children.

Pulmonary Interstitial Emphysema Complicating Pneumonia in an Unventilated Term Infant

“…Air-space consolidations and ground glass densities in the both lungs are noted selective bronchial occlusion, a short course of steroids, and high-frequency ventilation [3]. Surgical intervention may be considered for some persistent cases with resectable expansile lesions causing pulmonary dysfunction, cardiovascular compromise, recurrent infections or recurrent pneumothoraces, or for a definitive diagnosis in equivocal cases [8].…”

Premature Bebekte Pulmoner İnterstisyel Amfizem

“…Bazı vakalarda konservatif yaklaşımlar ve spontan iyileşmenin beklenmesi de yeterli olmuştur (11). Ventilatörde izlenen hastalarda tepe inspiryum basıncı, pozitif ekspiryum sonu basıncı ve inspiryum zamanı, hastanın oksijenasyonunu idame ettirebilecek en alt seviyeye çekilir.Ayrıca tek taraflı olan vakalarda amfizemli taraf altta kalacak şekilde hastayı lateral dekübit pozisyonunda yatırmak, selektif bronşial entübasyon ve yüksek hızda titreşimli ventilasyon (High-Frequency Oscillatory Ventilation, HFOV) kullanılan diğer tedavi yöntemleridir (12)(13)(14).…”

A cystic pulmonary lesion in an infant

“…Spontaneous resolution of both localized and diffuse PPIE has been reported. 2 This case demonstrates that even large localized PPIE lesions can resolve spontaneously, and that a conservative …”

“…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.…”

“…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. 1 The management of PPIE is either surgical or conservative, depending on the severity of respiratory symptoms.…”