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    Go to the top of the page   ID: 20030203141918 Original case in english  More links about this topic on Pubmed (PubMed Reader)
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    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918


     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     Pediatric Radiology CasesAuthor/s:

    Fritz Schneble (Regensburg)  

     
     Pediatric Radiology CasesEmail Address:

    Viewable for logged on visitors (Log on)  

     
     Pediatric Radiology CasesAge:

    Preterm  

     
     Pediatric Radiology CasesGender:

    N/A  

     
     Pediatric Radiology CasesRegion-Organ:

    Thorax-Lung  

     
     Pediatric Radiology CasesMost likely etiology:

    other  

     
     Pediatric Radiology CasesHistory:

    Premature twin born 27+2 gestational week. Birth weight: 770 g, fetofetal transfusion syndrome (donor), persistent Botalli's duct.  

     
     Pediatric Radiology CasesPathomorphology or Pathophysiology of this disease :

    Primary pulmonary immaturity;
    No prenatal steroid-lung-maturity treatment;
    Barotrauma of the lungs;
    Even after surfactant dose was given (2 times), difficult breathing situation, which caused a conventional respiration with high respiration pressures, then conventional respiration, later high frequency oscillation respiration (HFO).  

     
     Pediatric Radiology CasesRadiological findings:


    X-Ray 1 <- view X-Ray 1

    X-Ray 1: Image after primary intubation. "White Lung" corresponding to an respiratory distress syndrome IV°





    X-Ray 2 <- view X-Ray 2

    X-Ray 2: 2. day of life. Discrete, fine-granular pattern increase on both sides are still seen. The left side is discretely less ventilated. Clinical picture has improved.




    X-Ray 3 <- view X-Ray 3

    X-Ray 3: Interstitial emphysema with cystic and tubular radiolucencies on both sides. (bubble-type I with transition to type II)




    X-Ray 4 <- view X-Ray 4

    X-Ray 4: Clear increase of the interstitial emphysema (bubble type II), right side is more afflicted than the left.




    X-Ray 5 <- view X-Ray 5

    X-Ray 5:Massive increase of the interstitial emphysema on the right side. More discrete changes on the left side in decreased ventilation Some mediastinal shifting to the left.





     

     
     Pediatric Radiology CasesDiagnosis confirmation:

    Total constellation (Consens)  

     
     Pediatric Radiology CasesWhich DD would be also possible with the radiological findings:

    N/A  

     
     Pediatric Radiology CasesCourse / Prognosis / Frequency / Other :

    Breathing complications above all in a very underdeveloped neonate.
    Early stages of interstitial emphysema (IE) are under modification of the breathing regimen quickly reversible.
    From the beginning of difficult breathing situations with a very high pressure in conventional respiration and in high-frequencey oscillation respiration 2 x surfactant application.
    Some patients with more one-sided pulmonary IE profit from one-sided respiration to the less afflicted lung. The selective intubation and respiration of the left lung was not possible in our very small and instable patient. The patient died on the 7th day of life.

    Principles of treatment: Reduction of the respiration pressures. The goal was for a quick extubation. Children often tend to do better when switched to high-frequency oscillation respiration.  

     
     Pediatric Radiology CasesComments of the author about the case:

    If half of the lung is affected, as in our patient, an improvement of the findings in some patients is remarkable, if the child is selectively respirated over the non-affected lung.
    In our very small, extremely instable patient, a selective intubation in the right main bronchus was not possible!  

     
     Pediatric Radiology CasesFirst description / History:

    Staging according to Swischuk 1977

    Stage I: Bubble-type I: 1-1.5 mm diameter round or oval opacity. These represent the overfilled terminal bronchioli and alveolar ducts. There is no extraalveolar air escape.

    Stage II: Bubble-type II: After rupture of the alveoli, air escapes perivascularly to the periphery, as well as towards the hilus. The pulmonary opaque figures are larger with wormy apects.
    In further courses, larger pseudocysts can form. There is a higher risk for a pneuomothorax/pneumomediastinum.  

     
     Pediatric Radiology CasesLiterature:

    1. Medline: Medline
    Swischuk LE
    Bubbles in hyaline membrane disease
    Radiology 122:417 (1977)

    2. Medline: Medline
    Oppermann H.C., Wille L, Ulmer H.E.
    Der Neugeborenenthorax
    Springer 1982 (56-61)  

     
     Pediatric Radiology CasesKeywords:

    respiratory distress syndrome, RDS, Pulmonary interstitial emphysema, pulmonary, interstitial emphysema, infantile respiratory distress syndrome, IRDS, grade I, grade 1, premature, child, childhood, pediatric radiology  

     
     Pediatric Radiology Cases Cite this article:

    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918  

     
     Pediatric Radiology Cases Read similar articles: with corresponding keywords
    in the same field: Thorax-Lung
    or in the region: Thorax
    or in the tissue/organ: Lung
    or with the etiology: other
     
     Pediatric Radiology CasesImages to this case: There are X-Ray-images available for this case. [ X-Ray ] View all modalities [ All ]   
     
    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918


     

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    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Other cases by these authors:

    Search Fritz Schneble in Medline Fritz Schneble (7)   

    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)  
     
    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918


     

    Which diagnosis have other collegues guessed?


    • Pneumothorax in it's course
      Votes: 3 (21 %)


    • Pneumocystis carinii infection
      Votes: 1 (7 %)


    • Interstitial pulmonary emphysema
      Votes: 8 (57 %)


    • Cystic adenomatous malformation of the lung
      Votes: 2 (14 %)



        Total answers: 14

     
    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918


     

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    Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS)
    Fritz Schneble. Pulmonary interstitial emphysema after grade IV respiratory distress syndrome (RDS). PedRad [serial online] vol 3, no. 2.
    URL: www.PedRad.info/?search=20030203141918


     




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