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Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
Etiology/Pathophysiology:
Complication of mechanical ventilation in neonates with respiratory
distress. The interstitial air collects as a multitude of small
distinct bubbles of extra-alveolar air causing increased lung volume
and acting as a pulmonary splint to stiffen the lung leading to
compromise of pulmonary ventilation and vascular perfusion (air
block). If high pressure ventilation continues, the bubbles of
interstitial air coalesce, further worsening the air block. PIE is
almost always a precursor to progressive air leak and tension
pneumothorax.
Pathology:
Air in the pulmonary interstitium.
Imaging Findings:
Usually unilateral hyperinflation, that causes mediastinal shift.
Small distinct cyst like lucencies that may be round, linear or oval
are distributed uniformly in the affected area of lung and persist
throughout the respiratory cycle.
The increased lung volume is evidenced by
flattening of the diaphragm and increased transverse and AP chest
diameters. Pneumomediastinum and pneumothorax are
frequently seen complications.
DDX:
References:
See References Chapter.
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