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A case of localized persistent interstitial pulmonary emphysema
Insights
Localized persistent interstitial pulmonary emphysema (LPIPE) can occur in full-term infants without ventilation. This rare condition presents as a single-lobe air collection, requiring differentiation from other congenital lung abnormalities.
Area of Science:
- Pediatric Pulmonology
- Neonatology
- Radiology
Background:
- Interstitial pulmonary emphysema (IPE) is a known complication of mechanical ventilation in premature infants with respiratory distress syndrome.
- Localized persistent interstitial pulmonary emphysema (LPIPE) is a rare variant, typically associated with ventilation support.
Observation:
- A case of LPIPE was incidentally found in a 4-day-old, otherwise healthy, full-term infant.
- The infant had no history of respiratory distress or assisted mechanical ventilation.
- Radiographic findings included a radiolucent area in the right lower lobe, necessitating differential diagnosis.
Findings:
- Computed tomography (CT) scan revealed irregular air-cystic spaces.
- Pathological examination showed cystic walls composed of compressed lung parenchyma and connective tissue, with multinucleated giant cells.
Implications:
- This case highlights that LPIPE can occur in term infants without ventilation, expanding its known etiology.
- Accurate differential diagnosis, including congenital cystic adenomatoid malformation and congenital lobar emphysema, is crucial for appropriate management.
- Further research into non-ventilator-associated LPIPE is warranted.
Abstract:
Interstitial pulmonary emphysema is a well-documented complication of assisted mechanical ventilation in premature infants with respiratory distress syndrome. Localized persistent interstitial pulmonary emphysema (LPIPE) confined to a single lobe was incidentally presented in a 4-day-old female infant. This patient was a normal full-term baby with no respiratory distress symptom and no experience of assisted mechanical ventilation. Chest radiograph showed radiolucent area in right lower lobe zone, which needed differential diagnosis from other congenital lesions such as congenital cystic adenomatoid malformation and congenital lobar emphysema. CT scan showed irregular-shaped air cystic spaces and pathologically, cystic walls primarily consisted of compressed lung parenchyma and loose connective tissue intermittently lined by multinucleated foreign body giant cells.