An Additional Treatment Option for One-Sided Pulmonary Emphysema – A Case Report

Introduction

Pulmonary interstitial emphysema (PIE) is associated with severe morbidity and mortality in VLBW infants. Overdistention and pressure gradient between the negative pressure in the pleural cavity and positive mean airway pressure might lead to alveolar rupture, causing air collection in pulmonary interstitium. Risk factors for PIE are preterm birth, respiratory distress syndrome and mechanical ventilation, one-sided PIE is associated with malposition of the endotracheal tube(Cohen et al., J Pediatr 1984; 104: 441–443; Kempley et al., Resuscitation 2008; 77: 369–373).

Few systematic reviews address this condition, and even fewer reports focus on the problem of patients not responding to standard conservative procedures (high inspired oxygen concentrations, steroid treatment, lateral positioning, short inspiration times and high-frequency oscillation)(Gortner et al., Monatsschr Kinderheilkd. 1988 Aug;136: 432–435.; Fitzgerald et al., Biol Neonate 1998; 73: 34–39; Leonidas et al., J Pediatr 1975; 87: 776–778; Squires et al., Neonatology 2013; 104: 243–249). More invasive treatment options are selective ventilation of the contralateral lung, lung puncture, high-frequency ventilation, and lobe resection(Dördelmann et al., Eur J Pediatr Surg 2008; 18: 233–236; Gaylord et al., Pediatrics 1987; 79: 915–921; Rettwitz-Volk et al., Acta Paediatr 1993; 82: 190–192; Schneider et al., J Thorac Cardiovasc Surg 1985; 89: 332–339).