Pulmonary interstitial emphysema
Pulmonary interstitial emphysema is a collection of air outside of the normal air space of the pulmonary alveoli, found instead inside the connective tissue of the peribronchovascular sheaths, interlobular septa, and visceral pleura. This collection of air develops as a result of alveolar and terminal bronchiolar rupture. Pulmonary interstitial emphysema is more frequent in premature infants who require mechanical ventilation for severe lung disease. Infants with pulmonary interstitial emphysema are typically recommended for admission to a neonatal intensive care unit.
Cause
Pulmonary interstitial emphysema is a concern in any of the following:- Prematurity
- Infant respiratory distress syndrome
- Meconium aspiration syndrome
- Amniotic fluid aspiration
- Sepsis
- Infections
- Mechanical ventilation
Pathophysiology
Pulmonary interstitial emphysema is created when air bursts or ruptures through tissue from the alveoli and bronchioles into the perivascular tissue of the lung.Diagnosis
A chest X ray may show a "salt and pepper" appearance due to the linear lucencies that are present.Treatment
Different treatments have been used to manage pulmonary interstitial emphysema with variable success. Admission/transfer to a neonatal intensive care unit is common and expected for patients with PIE. Treatments include:- Lateral decubitus position with the affected side down
- High-frequency ventilation
- Lobectomy
- Selective Main Bronchial Intubation and Occlusion