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CT Findings and Temporal Course of Persistent Pulmonary Interstitial Emphysema in Neonates: A Multiinstitutional Study

Lane F. Donnelly1, Javier Lucaya2, Vanildo Ozelame3, Donald P. Frush4, Peter J. Strouse5, Thomas E. Sumner6 and Harriet J. Paltiel7

1 Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH 45229-3039.
2 Institut de Diagnostic per la Imatge, Barcelona, Spain 08035.
3 Hospital Infantil Joana de Gusmao, Florianopolis, Santa Catarina, Brazil CEP 88015-390.
4 Department of Radiology, Duke University Medical Center, Durham, NC 27710.
5 Department of Radiology, University of Michigan, Ann Arbor, MI 48103.
6 Department of Radiology, Wake Forest University, Winston Salem, NC 27157-1088.
7 Department of Radiology, Children's Hospital, Boston, MA 02115.



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  		Fig. 1A. —Persistent pulmonary interstitial emphysema in 25-day-old premature infant girl. Chest radiograph at 25 days of life shows multiple cystic radiolucencies within entire right lung. Note hyperexpansion with mediastinal shift to left.

 


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  		Fig. 1B. —Persistent pulmonary interstitial emphysema in 25-day-old premature infant girl. CT scan obtained 5 days after A shows multiple radiolucent cystic structures that involve right upper, middle, and lower lobes. Note multiple soft-tissue density linear and punctuate structures (arrows) in cystic radiolucencies.

 


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  		Fig. 2A. —Line-and-dot pattern on CT scans in infants with persistent pulmonary interstitial emphysema. CT scans show multiple cystic radiolucencies that occupy all lobes of right lung in 2-month-old premature girl (A) and all lobes of right lung in 1-month-old premature girl (B). Note solid linear and dotlike structures (arrows) in air-filled cysts.

 


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  		Fig. 2B. —Line-and-dot pattern on CT scans in infants with persistent pulmonary interstitial emphysema. CT scans show multiple cystic radiolucencies that occupy all lobes of right lung in 2-month-old premature girl (A) and all lobes of right lung in 1-month-old premature girl (B). Note solid linear and dotlike structures (arrows) in air-filled cysts.

 


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  		Fig. 3A. —Resolution of persistent pulmonary interstitial emphysema over time in premature infant boy. Chest radiograph obtained at 15 days of life shows hyperradiolucent cystic structures in left upper lobe.

 


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  		Fig. 3B. —Resolution of persistent pulmonary interstitial emphysema over time in premature infant boy. CT scan obtained at 20 days of life shows hyperradiolucent cystic structures in left upper lobe with line-and-dot pattern.

 


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  		Fig. 3C. —Resolution of persistent pulmonary interstitial emphysema over time in premature infant boy. CT scan obtained at 40 days of life shows resolution of cystic radiolucencies. Lung now appears normal.

 


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  		Fig. 4A. —Interval increase in size of radiolucent cysts over prolonged period in infant girl with persistent pulmonary interstitial emphysema. CT scan obtained at 100 days of life shows multiple cystic radiolucencies in lower lobes bilaterally. Radiolucency can be seen adjacent to multiple pulmonary vessels.

 


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  		Fig. 4B. —Interval increase in size of radiolucent cysts over prolonged period in infant girl with persistent pulmonary interstitial emphysema. CT scan obtained 1 year after A shows interval increase in size of cysts in lower lobes. At time our article was accepted, child remained stable clinically and follow-up was ongoing.

 

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