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Age: 1 month

Sex: Female

Indication: Respiratory distress

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Case #5


Findings

  • Endotracheal tube with tip overlying the T4 vertebral body
  • Enteric tube terminates in the stomach
  • Left lower extremity approach PICC with tip overlying the upper inferior vena cava near the cavoatrial junction
  • Bubbly lucencies throughout the right greater than left lungs on a background of hyperinflation and diffuse groundglass opacification


Diagnosis

  • Pulmonary interstitial emphysema (PIE)

Sample Report

Endotracheal tube with tip overlying the T4 vertebral body.

Enteric tube terminates in the stomach.

Left lower extremity approach PICC with tip overlying the upper inferior vena cava near the cavoatrial junction.

Bubbly lucencies throughout the right greater than left lungs, consistent with pulmonary interstitial empysema. No pneumothorax. Pulmonary hyperinflation with background chronic lung changes.


Discussion

  • Pulmonary interstitial emphysema (PIE) is a manifestation of barotrauma and almost always occurs in ventilated patients. Gas dissects along the pulmonary interstitium and can also result in pneumothorax or pneumomediastinum
  • The team should be immediately notified when this finding is made so they can try to prevent further damage
  • Less commonly, PIE can be more focal and even cystic looking, such that it can mimic other pathologies like congenital lobar overinflation or CPAM



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