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Neonatal Focal Hyperaeration of the Lungs (Wilson-Mikity Syndrome)

1965; Radiological Society of North America; Volume: 85; Issue: 3 Linguagem: Inglês

10.1148/85.3.409

1527-1315

Herman Grossman, Walter E. Berdon, Abraham Mizrahi, David H. Baker, Herman Grossman,

Pleural and Pulmonary Diseases

AHITHERTO undescribed form of respiratory distress in premature infants was reported by Wilson and Mikity in 1960 (8), associated with roentgenographic visualization of coarse thickening of the interstitial structures of the lungs. Since then, similar instances have been described under the terms “cystic emphysema” (3), “pulmonary dysmaturity” (1), and “a new form of lung fibrosis in premature infants” (4, 5). The onset of symptoms varies between birth and the thirty-fifth day of life, with a mean of eight days. The outstanding symptom is cyanosis requiring oxygen. Auscultation of the lungs is clear in some infants, in others râles, rhonchi, and/or wheezing are revealed. In infants who survive the neonatal period, the chest roentgenogram clears within a period of several months. The purpose of this communication is to discuss the criteria for the x-ray diagnosis of neonatal focal hyperaeration and to demonstrate the sequence of roentgen findings. Material and Methods During the two-year period (January 1963–December 1964) 8 premature infants and one full-term infant were seen at Babies Hospital, New York, in whom the roentgen appearance described by Wilson and Mikity was noted. Maternal and neonatal histories as well as chest films obtained in the neonatal period were reviewed. Clinical and radiographic follow-up examinations were undertaken periodically in all infants until complete clearing occurred. One infant observed in 1959 died at seven months of age from an unrelated disease, and the postmortem findings will be discussed. Roentgen Findings On the basis of this study, the roentgen findings in neonatal focal hyperaeration point to three stages of the disorder: acute, intermediate, and clearing. 1. Acute Stage: Chest roentgenograms obtained at the onset of clinical symptoms were reasonably similar. They showed a bilateral diffuse reticulonodular or reticular pattern with small, round, lucent foci producing a “bubbly” appearance (Figs. 1,A, 2,A, 3,A, 4,A, 5,B, 6, 7). Generalized hyperaeration was common (Fig. 4,A, 6). 2. Intermediate Stage In a period of weeks to months the pattern in the lungs changed to coarse streaks radiating from the hilus, most commonly into the upper lobes (Figs. 1,B, 2,B, 4,B). The focal lucent areas disappeared, but the hyperaeration persisted and was often more marked than on the earlier roentgenograms (Fig. 2, C). 3. Clearing Stage: Complete disappearance of the roentgenologic abnormalities occurred between four and eleven months of age (Fig. 1,C, 3,B). Clinical Findings The age at the onset of respiratory difficulty varied between the first day of life and three weeks. Birth weight ranged from 790 to 1,380 g, except for one full-term infant who weighed 3,100 g. All infants, with the exception of the full-term, were born before thirty-two weeks of gestation.