Fritz Schneble (Regensburg)  

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Preterm  

N/A  

Thorax-Lung  

other  

Premature twin born 27+2 gestational week. Birth weight: 770 g, fetofetal transfusion syndrome (donor), persistent Botalli's duct.  

Primary pulmonary immaturity;
No prenatal steroid-lung-maturity treatment;
Barotrauma of the lungs;
Even after surfactant dose was given (2 times), difficult breathing situation, which caused a conventional respiration with high respiration pressures, then conventional respiration, later high frequency oscillation respiration (HFO).  

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X-Ray 1: Image after primary intubation. "White Lung" corresponding to an respiratory distress syndrome IV°





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X-Ray 2: 2. day of life. Discrete, fine-granular pattern increase on both sides are still seen. The left side is discretely less ventilated. Clinical picture has improved.




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X-Ray 3: Interstitial emphysema with cystic and tubular radiolucencies on both sides. (bubble-type I with transition to type II)




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X-Ray 4: Clear increase of the interstitial emphysema (bubble type II), right side is more afflicted than the left.




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X-Ray 5:Massive increase of the interstitial emphysema on the right side. More discrete changes on the left side in decreased ventilation Some mediastinal shifting to the left.





 

Total constellation (Consens)  

N/A  

Breathing complications above all in a very underdeveloped neonate.
Early stages of interstitial emphysema (IE) are under modification of the breathing regimen quickly reversible.
From the beginning of difficult breathing situations with a very high pressure in conventional respiration and in high-frequencey oscillation respiration 2 x surfactant application.
Some patients with more one-sided pulmonary IE profit from one-sided respiration to the less afflicted lung. The selective intubation and respiration of the left lung was not possible in our very small and instable patient. The patient died on the 7th day of life.

Principles of treatment: Reduction of the respiration pressures. The goal was for a quick extubation. Children often tend to do better when switched to high-frequency oscillation respiration.  

If half of the lung is affected, as in our patient, an improvement of the findings in some patients is remarkable, if the child is selectively respirated over the non-affected lung.
In our very small, extremely instable patient, a selective intubation in the right main bronchus was not possible!  

Staging according to Swischuk 1977

Stage I: Bubble-type I: 1-1.5 mm diameter round or oval opacity. These represent the overfilled terminal bronchioli and alveolar ducts. There is no extraalveolar air escape.

Stage II: Bubble-type II: After rupture of the alveoli, air escapes perivascularly to the periphery, as well as towards the hilus. The pulmonary opaque figures are larger with wormy apects.
In further courses, larger pseudocysts can form. There is a higher risk for a pneuomothorax/pneumomediastinum.  

1. Medline:
Swischuk LE
Bubbles in hyaline membrane disease
Radiology 122:417 (1977)

2. Medline:
Oppermann H.C., Wille L, Ulmer H.E.
Der Neugeborenenthorax
Springer 1982 (56-61)  

respiratory distress syndrome, RDS, Pulmonary interstitial emphysema, pulmonary, interstitial emphysema, infantile respiratory distress syndrome, IRDS, grade I, grade 1, premature, child, childhood, pediatric radiology  

Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
URL: www.PedRad.info/?search=20030203141918