PMC5439261_01
(a) CXR shows linear lucencies suggestive of PIE in both lungs on 6th day of life. (b) CXR shows bilateral PIE with cystic lesion in left lower lobe on 17th day of life.
CRIPE2017-6907329.001.jpg
PMC5439261_01_CRIPE2017-6907329.001.jpg
fig1
On the fifth day of life, he had recurrent oxygen desaturations and repeat CXR showed pulmonary interstitial emphysema (PIE) in both lungs (Figure 1(a)). The cystic lesion in the left lower lobe gradually increased in size to 33 mm in diameter in the next two weeks (Figure 1(b)).
(a) Radiograph of chest and abdomen shows pneumothorax, pneumoperitoneum, and cystic lesion in the left lower lobe. (b) Right lateral decubitus view of chest and abdomen shows left sided pneumothorax with pneumoperitoneum.
CRIPE2017-6907329.002.jpg
PMC5439261_01_CRIPE2017-6907329.002.jpg
fig2
His blood gases showed significant respiratory acidosis. He developed tension pneumothorax on left side with pulmonary interstitial emphysema and pneumoperitoneum (Figures 2(a) and 2(b)). His abdomen was distended but remained soft with bowel sounds. He had emergent chest tube placement.
(a) Gross image of the left lung with 4 mm cystic lesion in left lower lobe. (b) Histology of left lower lobe cystic lesion lined by inflammatory cells and fibrosis.
CRIPE2017-6907329.003.jpg
PMC5439261_01_CRIPE2017-6907329.003.jpg
fig3
Autopsy confirmed premature lungs appropriate for gestational age, pulmonary interstitial emphysema in both lungs, 4 mm cystic lesion lined by fibrous tissue in left lower lobe which may represent localized pulmonary interstitial emphysema (Figures 3(a) and 3(b)), and congested and dilated loop of transverse colon with no macroscopic or microscopic evidence of perforation or pneumatosis intestinalis.