Topics Discussed: interstitial emphysema of lung; mediastinal emphysema; neonatal pulmonary air leak; pneumopericardium; pneumoperitoneum; pneumothorax; pulmonology and respiratory medicine; retropneumoperitoneum.
Excerpt:"Definition. The pulmonary air leak syndromes (pneumomediastinum, pneumothorax, pulmonary interstitial emphysema [PIE], pneumopericardium, pneumoperitoneum, and pneumoretroperitoneum) comprise a spectrum of disease with the same underlying pathophysiology. Overdistention of alveolar sacs or terminal airways leads to disruption of airway integrity, resulting in dissection of air into extra-alveolar spaces.
Incidence. The exact incidence of the air leak syndromes is difficult to determine. Pneumothorax is the most common of the air leak syndromes, reported to occur spontaneously in 1–2% of neonates. The incidence increases in preterm infants to about 6%. The incidence also increases in infants with underlying lung disease (such as respiratory distress syndrome [RDS], meconium aspiration, pneumonia, and pulmonary hypoplasia) who are on ventilatory support and in infants who had vigorous resuscitation at birth.
Pathophysiology. Overdistention of terminal air spaces or airways—the common denominator in all the pulmonary air leaks—can result from uneven alveolar ventilation, air trapping, or injudicious use of alveolar-distending pressure in infants on ventilatory support. As lung volume exceeds physiologic limits, mechanical stresses occur in all planes of the alveolar or respiratory bronchial wall, with eventual tissue rupture. Air can track through the perivascular adventitia, causing PIE, or dissect along vascular sheaths toward the hilum,..."
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