Neonatal pneumothorax

Case contributed by Dr. Roy Waknin


A 4-day-old premature baby girl born at 31 weeks gestation presented with respiratory distress syndrome (RDS) requiring intubation and positive pressure ventilation (PPV).

Patient Data

Age: 4 days
Gender: Female

Irregular branching lucencies in the right perihilar region are concerning for pulmonary interstitial emphysema (PIE) in this baby with RDS and PPV.

There is diffuse bilateral near-symmetric haziness of the lung fields, consistent with respiratory distress syndrome (RDS).

The endotracheal tube terminating at the level of T1. The orogastric tube courses into the stomach.


Small anteromedial right pneumothorax with free air in the right perihilar region, surrounding the blood vessels and bronchioles, consistent with pulmonary interstitial emphysema (PIE).

Diffuse symmetric haziness in both lungs is consistent with RDS.

No left pneumothorax or PIE.

Case Discussion

This baby girl born at 31 weeks gestation presented with respiratory distress syndrome (RDS) at birth, the most common cause of distress in premature babies. She required intubation, surfactant administration, and positive pressure intubation to assist her breathing.

At 4 days old, imaging findings confirmed pulmonary interstitial emphysema (PIE) leading to a right-sided pneumothorax, most likely consequent to the positive pressure ventilation.


This case was submitted with supervision and input from:

Soni C. Chawla, M.D.                                                                                                
Associate Professor                                       
Department of Radiological Sciences                      
David Geffen School of medicine at UCLA               
Olive View-UCLA Medical Center

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