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Age: 11 days (born at 32 weeks)

Sex: Male

Indication: Evaluate endotracheal tube

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Case #5


Findings

  • Endotracheal tube tip projects at the level of T2, approximately 5 mm above the carina
  • Enteric tube terminates in the distal esophagus
  • Right lower extremity PICC with tip at the level of T11
  • Branching lucencies in the left lung with hyperlucency of the medial left lung base overlying the cardiac silhouette
  • Mild groundglass opacification throughout the right lung
  • Mild enlargement of the cardiothymic silhouette
  • No pleural effusion
  • Paucity of bowel gas in the right hemiabdomen without dilated bowel loops


Diagnosis

  • Pulmonary interstitial emphysema (PIE)

Sample Report

Endotracheal tube tip projects at the level of T2, approximately 5 mm above the carina.

Enteric tube terminates in the distal esophagus. Recommend advancing 2 cm for placement in the stomach.

Right lower extremity PICC with tip at the level of T11.

Branching lucencies in the left lung are concerning for pulmonary interstitial emphysema (PIE). Hyperlucency of the medial left lung base overlying the cardiac silhouette may represent a pneumatocele or medial pneumothorax. Recommend attention on close interval followup imaging.

Mild groundglass opacification throughout the right lung, which may relate to respiratory distress syndrome and/or edema.

Mild enlargement of the cardiothymic silhouette.

No pleural effusion.

Paucity of bowel gas in the right hemiabdomen without overt evidence of bowel obstruction.


Discussion

  • Look closely for pulmonary interstitial emphysema (PIE) in intubated infants. Findings are often asymmetric, as in this case, which makes them easier to find
  • This case shows a less common cystic appearance of PIE in the left lung base, which is difficult to distinguish from a medial pneumothorax, congenital lobar overinflation (though this almost always occurs in the upper lobes), or CPAM



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