Title:A Case of Pulmonary Interstitial Emphysema and Systematic Review of
Literature in Management Approach
Volume: 19
Issue: 4
Author(s): Domenico Paolo La Regina, Roberta Arena, Riccardo Riccardi, Paolo Di Renzi, Luigi Orfeo and Fabio Midulla*
Affiliation:
- Department of Maternal Infant and Urological Sciences, Sapienza University of Rome, Rome, Italy
Keywords:
Pulmonary interstitial emphysema, air leaks, cystic lung lesion, pediatric, epidemiology, ventilatory assistance.
Abstract:
Background: Pulmonary interstitial emphysema (PIE) is a rare pathology characterized
by the abnormal and harmful presence of air in the interstitial tissues of the lung. This condition is
often related to barotrauma caused by mechanical ventilation, but it can be exceptionally seen in
healthy infants. The main causes of PIE are respiratory distress syndrome (RDS), mechanical ventilation
or positive pressure ventilation, prematurity, meconium aspiration syndrome, pulmonary infection,
amniotic fluid aspiration, and incorrect endotracheal tube placement. To date, there is no
standard treatment for PIE, based on the clinical and localization of PIE conservative and non--
conservative therapies are described.
Methods: We describe a case of a very premature infant with severe respiratory failure secondary
to RDS and unilateral left sided PIE with lung herniation treated with conservative therapy like selective
intubation, steroid therapy, lateral position, and lastly, oxygen supplementation without ventilatory
assistance. Furthermore, we have carried out a systematic literature review for the past 15
years (2007-2022). A systematic review, using an evidence-based algorithmic approach, was conducted
following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)
guidelines.
Results: Our search, after the selection, produced a total of 24 articles, which were revised.
Conclusion: In our case oxygen supplementation without ventilatory assistance resulted in successful
resolution of the left PIE. Discontinuation of ventilatory care played a crucial role. Considering
the management reported in literature, our aim is to perform a systematic literature review by adding
our experience to the available knowledge on therapy for unilateral PIE.
