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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Abbreviations
Pulmonary interstitial emphysema (PIE)
Definitions
Air within pulmonary interstitium & lymphatics
Most commonly secondary to barotrauma of positive pressure mechanical ventilation in setting of prematurity, very or extremely low birth weight, & surfactant deficiency disease (SDD)
Part of "neonatal air leak syndrome": Air escapes tracheobronchial tree to reside in other spaces
Also includes pneumomediastinum, pneumothorax, pneumopericardium, pneumoperitoneum, pneumatocele, subcutaneous emphysema, air embolism
May occur in neonate with pulmonary hypoplasia on mechanical ventilation or in setting of meconium aspiration or sepsis
Rarely occurs in older patients with underlying lung disease or Valsalva leading to alveolar rupture
Stem cell transplant with graft vs. host disease & bronchiolitis obliterans
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Reporting Tips
Selected References
Kim HR et al: Presence of subpleural pulmonary interstitial emphysema as an indication of single or multiple alveolar ruptures on CT in patients with spontaneous pneumomediastinum. Acta Radiol. ePub, 2016
Mahapatra S et al: Steroid-induced resolution of refractory pulmonary interstitial emphysema. J Matern Fetal Neonatal Med. 1-4, 2016
Barcia SM et al: Pulmonary interstitial emphysema in adults: a clinicopathologic study of 53 lung explants. Am J Surg Pathol. 38(3):339-45, 2014
Corsini I et al: Pulmonary interstitial emphysema after resolution of relapsing pneumothorax and discontinuation of mechanical ventilation. An atypical case in a preterm infant. J Matern Fetal Neonatal Med. 27(15):1610-2, 2014
Squires KA et al: High-frequency oscillatory ventilation with low oscillatory frequency in pulmonary interstitial emphysema. Neonatology. 104(4):243-9, 2013
Jeng MJ et al: Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc. 75(11):551-9, 2012
Srinivasan R et al: Persistent pulmonary interstitial emphysema presenting as solitary lung cyst in a preterm infant. BMJ Case Rep, 2012
Joseph LJ et al: Unilateral lung intubation for pulmonary air leak syndrome in neonates: a case series and a review of the literature. Am J Perinatol. 28(2):151-6, 2011
Gonçalves CA et al: Pulmonary lobar interstitial emphysema. Fetal Pediatr Pathol. 28(4):192-7, 2009
Jassal MS et al: Spontaneous resolution of diffuse persistent pulmonary interstitial emphysema. Pediatr Pulmonol. 43(6):615-9, 2008
Phatak RS et al: Heliox with inhaled nitric oxide: a novel strategy for severe localized interstitial pulmonary emphysema in preterm neonatal ventilation. Respir Care. 53(12):1731-8, 2008
Franquet T et al: Air-leak syndromes in hematopoietic stem cell transplant recipients with chronic GVHD: high-resolution CT findings. J Thorac Imaging. 22(4):335-40, 2007
Donnelly LF et al: CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study. AJR Am J Roentgenol. 180(4):1129-33, 2003
Cohen MC et al: Solitary unilocular cyst of the lung with features of persistent interstitial pulmonary emphysema: report of four cases. Pediatr Dev Pathol. 2(6):531-6, 1999
Jabra AA et al: Localized persistent pulmonary interstitial emphysema: CT findings with radiographic-pathologic correlation. AJR Am J Roentgenol. 169(5):1381-4, 1997
Related Anatomy
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Related Differential Diagnoses
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Clinical Issues
TERMINOLOGY
Abbreviations
Pulmonary interstitial emphysema (PIE)
Definitions
Air within pulmonary interstitium & lymphatics
Most commonly secondary to barotrauma of positive pressure mechanical ventilation in setting of prematurity, very or extremely low birth weight, & surfactant deficiency disease (SDD)
Part of "neonatal air leak syndrome": Air escapes tracheobronchial tree to reside in other spaces
Also includes pneumomediastinum, pneumothorax, pneumopericardium, pneumoperitoneum, pneumatocele, subcutaneous emphysema, air embolism
May occur in neonate with pulmonary hypoplasia on mechanical ventilation or in setting of meconium aspiration or sepsis
Rarely occurs in older patients with underlying lung disease or Valsalva leading to alveolar rupture
Stem cell transplant with graft vs. host disease & bronchiolitis obliterans
IMAGING
General Features
Radiographic Findings
CT Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Image Interpretation Pearls
Reporting Tips
Selected References
Kim HR et al: Presence of subpleural pulmonary interstitial emphysema as an indication of single or multiple alveolar ruptures on CT in patients with spontaneous pneumomediastinum. Acta Radiol. ePub, 2016
Mahapatra S et al: Steroid-induced resolution of refractory pulmonary interstitial emphysema. J Matern Fetal Neonatal Med. 1-4, 2016
Barcia SM et al: Pulmonary interstitial emphysema in adults: a clinicopathologic study of 53 lung explants. Am J Surg Pathol. 38(3):339-45, 2014
Corsini I et al: Pulmonary interstitial emphysema after resolution of relapsing pneumothorax and discontinuation of mechanical ventilation. An atypical case in a preterm infant. J Matern Fetal Neonatal Med. 27(15):1610-2, 2014
Squires KA et al: High-frequency oscillatory ventilation with low oscillatory frequency in pulmonary interstitial emphysema. Neonatology. 104(4):243-9, 2013
Jeng MJ et al: Neonatal air leak syndrome and the role of high-frequency ventilation in its prevention. J Chin Med Assoc. 75(11):551-9, 2012
Srinivasan R et al: Persistent pulmonary interstitial emphysema presenting as solitary lung cyst in a preterm infant. BMJ Case Rep, 2012
Joseph LJ et al: Unilateral lung intubation for pulmonary air leak syndrome in neonates: a case series and a review of the literature. Am J Perinatol. 28(2):151-6, 2011
Gonçalves CA et al: Pulmonary lobar interstitial emphysema. Fetal Pediatr Pathol. 28(4):192-7, 2009
Jassal MS et al: Spontaneous resolution of diffuse persistent pulmonary interstitial emphysema. Pediatr Pulmonol. 43(6):615-9, 2008
Phatak RS et al: Heliox with inhaled nitric oxide: a novel strategy for severe localized interstitial pulmonary emphysema in preterm neonatal ventilation. Respir Care. 53(12):1731-8, 2008
Franquet T et al: Air-leak syndromes in hematopoietic stem cell transplant recipients with chronic GVHD: high-resolution CT findings. J Thorac Imaging. 22(4):335-40, 2007
Donnelly LF et al: CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional study. AJR Am J Roentgenol. 180(4):1129-33, 2003
Cohen MC et al: Solitary unilocular cyst of the lung with features of persistent interstitial pulmonary emphysema: report of four cases. Pediatr Dev Pathol. 2(6):531-6, 1999
Jabra AA et al: Localized persistent pulmonary interstitial emphysema: CT findings with radiographic-pathologic correlation. AJR Am J Roentgenol. 169(5):1381-4, 1997
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