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Lung Ultrasound: A Useful Tool for the Follow-Up of Neonatal Localized Interstitial Emphysema

2015; Elsevier BV; Volume: 166; Issue: 6 Linguagem: Inglês

10.1016/j.jpeds.2015.02.016

1097-6833

Carla Balcells Esponera, Ruth del Río, Lucía Riaza, Mónica Rebollo, Javier Rodríguez‐Fanjul, Marta Camprubí‐Rimblas,

Atomic and Subatomic Physics Research

A 33-week-old girl was admitted to the neonatal intensive care unit because of respiratory distress. A ground glass appearance and air bronchograms were seen on the chest radiograph (Figure, 1a ). Lung ultrasound showed an alveolar interstitial syndrome pattern1Copetti R. Cattarossi L. Macagno F. Violino M. Furlan R. Lung ultrasound in respiratory distress syndrome: a useful tool for early diagnosis.Neonatology. 2008; 94: 52-59Crossref PubMed Scopus (201) Google Scholar: bilateral coalescent B-lines from the base to the apex and pleural thickness without spared areas (Figure, 1L and 1R). She required continuous positive airway pressure for 72 hours. After being asymptomatic for 1 week, she began to have tachypnea and subcostal retraction. Radiograph revealed an asymmetric inflation of both lungs with left-sided cystic lucencies (Figure, 2a). Lung ultrasound showed a normal pattern for the right lung, and on the left non-coalescent, vertically-oriented B-lines2Lichtenstein D.A. Ultrasound examination of the lungs in the intensive care unit.Pediatr Crit Care Med. 2009; 10: 693-698Crossref PubMed Scopus (97) Google Scholar were seen (Figure, 2L and 2R). A thoracic computed tomography demonstrated localized interstitial emphysema of the left upper lobe (Figure, 3). Conservative therapy with left decubitus positioning was started. Radiograph and lung ultrasound showed an improvement after 12 days; incipient A lines included in lighter comet-tail artifacts were seen (Figure, 4a, 4L, 4R). Clinical symptoms improved over the next 2 weeks and she was discharged at 38 days. Parents reported no significant respiratory symptoms at follow-up. At that moment, radiograph and lung ultrasound were normal (Figure, 5a, 5L, 5R). Localized interstitial emphysema is a rare entity that is seen in preterm infants requiring mechanical ventilation but it has also been reported in non-ventilated newborns.3Gürakan B. Tarcan A. Arda I.S. Coşkun M. Persistent pulmonary interstitial emphysema in an unventilated neonate.Pediatr Pulmonol. 2002; 34: 409-411Crossref PubMed Scopus (26) Google Scholar, 4Gessler P. Toenz M. Gugger M. Pfenninger J. Lobar pulmonary interstitial emphysema in a premature infant on continuous positive airway pressure using nasal prongs.Eur J Pediatr. 2001; 160: 263-264Crossref PubMed Scopus (15) Google Scholar, 5Berk D.R. Varich L.J. Localized persistent pulmonary interstitial emphysema in a preterm infant in the absence of mechanical ventilation.Pediatr Radiol. 2005; 35: 1243-1245Crossref PubMed Scopus (23) Google Scholar It is caused by the dissipation of gas from the alveoli into the pulmonary interstitium. As demonstrated, lung ultrasound seems to be a good tool for the diagnosis and follow-up of patients with localized interstitial emphysema. Neonatologists should be made aware of the usefulness of lung ultrasound in the diagnosis and monitoring of neonatal respiratory diseases in order to decrease the harmful effects of ionizing radiation in these patients.