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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
CT findings and temporal course of persistent pulmonary interstitial emphysema in neonates: a multiinstitutional
Lane F Donnelly1, Javier Lucaya, Vanildo Ozelame
1Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039, USA.
Insights
Persistent pulmonary interstitial emphysema in neonates often shows characteristic CT findings. While surgery is common, conservative management may be successful, with treatment decisions influenced by local medical practices.
Area of Science:
- Neonatal Medicine
- Pediatric Radiology
- Pulmonology
Background:
- Persistent pulmonary interstitial emphysema (PPIE) is a rare neonatal lung condition.
- It often arises in premature infants requiring mechanical ventilation.
- Accurate diagnosis and management are crucial for patient outcomes.
Purpose of the Study:
- To evaluate the computed tomography (CT) appearance of PPIE in neonates.
- To analyze the management strategies employed for PPIE.
- To assess the temporal course of PPIE under different treatments.
Main Methods:
- Retrospective review of 17 neonates with PPIE across seven institutions.
- Analysis of radiographic and CT scan findings, including lesion distribution and appearance.
- Comparison of surgical versus nonsurgical management and outcomes, including international variations.
Main Results:
- CT scans revealed hyperexpanded cystic lesions in all patients, with 82% showing a characteristic line-and-dot pattern.
- Most patients (9/17) eventually underwent surgical resection.
- Nonsurgical management over one year led to resolution in 40% of cases, with size decrease in 30% and enlargement in 30%.
Conclusions:
- Characteristic CT findings, including the line-and-dot pattern, are highly suggestive of PPIE.
- While surgical resection is frequently performed, initial conservative management can be effective.
- Surgical intervention rates varied significantly between the United States and other countries, suggesting cultural influences on treatment decisions.
Objective:
The purpose of this study was to evaluate the CT appearance, management, and temporal course of persistent pulmonary interstitial emphysema in neonates.
Materials And Methods:
Criteria for inclusion in the study group included neonates with a history of prematurity who required ventilation for lung disease, development of hyperexpanded radiolucent lung lesions after typical radiographic findings of pulmonary interstitial emphysema, and CT documentation of lung abnormalities. Radiographs and CT scans were reviewed for the anatomic distribution, appearance, and presence of classic lines or dots within a radiolucent mass. We compared the management (surgical vs nonsurgical) and the temporal course in nonsurgical cases for patients in the United States and patients outside the United States.
Results:
From seven institutions, we identified 17 patients who had persistent pulmonary interstitial emphysema with CT documentation. On CT, all lesions consisted of hyperexpanded cystic radiolucencies. Distribution was single-lobe in nine patients (left upper lobe, n = 5; left lower lobe, n = 3; right middle lobe, n = 1), multilobar in eight patients, and bilateral in six patients. Fourteen patients (82%) showed the characteristic line-and-dot pattern. All patients were initially treated conservatively; nine eventually underwent surgical resection with confirmation at pathology. Of 10 patients who underwent nonsurgical treatment for at least 1 year, lesions resolved in four patients, decreased in size in three asymptomatic patients, and enlarged in three patients, with eventual resection in two. Surgical resection was performed in 89% (8/9) of patients treated in the United States and in 13% (1/8) of patients treated outside the United States.
Conclusion:
Our study found that 82% of patients with persistent pulmonary interstitial emphysema had characteristic CT findings (central lines and dots surrounded by radiolucency). Although most patients in this series eventually underwent surgical resection, initial treatment can be conservative. The decision to perform surgery may have reflected the local medical culture.
