Perinatology.  2018 Mar;29(1):57-61. 10.14734/PN.2018.29.1.57.

Successful Treatment of a Term Neonate Developing Severe Pulmonary Interstitial Emphysema Unrelated to Mechanical Ventilation; the First Reported Case in Korea

• Kim JH
• Cho SW
• Kim SY
• Kim ES

• KMID: 2409114
• DOI: http://doi.org/10.14734/PN.2018.29.1.57

Abstract

Air leak syndrome is one of the main causes of respiratory failure which is defined as air escapes from intra-alveolar to extra-alveolar areas. The incidence of spontaneous air leak syndrome in premature infants is about 1-2%. Pulmonary interstitial emphysema (PIE) is a form of air leak syndrome which usually occurs in infants with poor lung compliance (such as respiratory distress syndrome) on inadequate mechanical ventilation. On the other hand, air leak syndrome in term infants without underlying lung disease is very rare. Especially, there is only one report in Korea regarding PIE in term infants who finally underwent surgery. We experienced a case of a term infant who developed severe PIE unrelated to conventional mechanical ventilation and successfully treated by high-frequency ventilation care without any invasive procedure.

Keyword

Pulmonary emphysema; Birth of full-term infant; Mechanical ventilation

MeSH Terms

Emphysema*
Hand
High-Frequency Ventilation
Humans
Incidence
Infant
Infant, Newborn*
Infant, Premature
Korea*
Lung Compliance
Lung Diseases
Pulmonary Emphysema
Respiration, Artificial*
Respiratory Insufficiency
Term Birth
United Nations

Figure

• 

  Fig. 1 Infantograms of the patient during admission. No abnormality at admission (A) and on CPAP (B). After respiratory deterioration, infantogram just after intubation (C) showed pneumomediastinum, small amount of right pneumothorax, and, PIE (arrow) at right lung. Resolved air leak after HFV (D). CPAP, continuous positive airway pressure; PIE, pulmonary interstitial emphysema; HFV, high frequency ventilation.

• 

  Fig. 2 Chest CT images (B, C) with correlation of the infantogram (A). White arrows (A, C) indicate RML PIE which is visible at the infantogram. Venules and arterioles (red arrows [B, C]) normally located inside bronchovascular sheath, are surrounded by huge amount of air suggesting PIE in the right lung. Chest CT also shows air extending to the mediastinum and pleural space (B, C). CT, computed tormography; RML, right middle lung; PIE, pulmonary interstitial emphysema.

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