Congenital > PIE

Pulmonary interstitial emphysema

Clinical:

Rupture at the bronchoalveolar junctions associated with mechanical ventilation allows the passage of air into the perivascular and peribronchial spaces which results in pulmonary interstitial emphysema [1]. Once PIE is established, air may dissect along the bronchovascular sheaths or lymphatic channels to form subpleural blebs [1]. These subpleural blebs can rupture and produce pneumpthorax [1]. Air can also dissect and produce pneumpmediastinum. pneumopericardium, or pneumoperitoneum [1,2]. The condition is typically bilateral, but can be unilateral or confined to one lobe [2]. PIE usually occurs in the first week of life, whereas BPD tends to produce lucencies that slowly evolve over the first 3-4 weeks [2].

X-ray:

On CXR, acute PIE appears as multiple bubbly tubular/nonbranching and cystic lucencies that fail to conform to the predictable branching pattern of air bronchograms [1].

REFERENCES:

(1) Radiographics 2005; Agrons G, et al. Lung disease in premature neonates: radiologic-pathologic correlation. 25: 1047-1073

(2) AJR 2018; Liszewski MC, Lee EY. Neonatal lung disorders: pattern re to diagnosis. 210: 964-975

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