Presentation
23/40 week infant. Progressive oxygen requirement.
Patient Data
Intubated 23 week neonate. Tube position appropriate. Lungs well inflated and clear.
Reduced lung volumes following a reduction in ventilatory pressure. No complication of mechanical ventilation.
ET and NG tube position appropriate. UVC tip position appears to be deviated to the right.
Bilateral (whole left lung, right upper lobe) increased lucency with streaky opacification. Appearances suggestive of pulmonary interstitial emphysema.
2 days later, the right upper lobe has resolved. We are left with unilateral left-sided pulmonary interstitial emphysema.
Case Discussion
Patients with respiratory distress syndrome may have relatively normal-appearing lungs on day 0, especially if they are on ventilatory support (and especially if there is a cuffed tube).
This case highlights the development of subtotal pulmonary interstitial emphysema and highlights that with modulation of ventilatory pressures, differential resolution may occur resulting in atypical patterns of residual disease.
In preterm babies with RDS, new focal areas of increased lucency with linear areas of opacification should trigger a thought about PIE. It doesn't need to be symmetrical or total-lung.
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