Pathology
Images
Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
Index
Contents
Authors
Up
Next
Back
×
+ Introduction
+ Support
+ Neonatal pathology
Pulmonary air leak
Introduction

Occurs predominantly in preterm infants with severe RDS requiring mechanical ventilation, the ventilation pressures must be high enough to prevent alveolar collapse in this situation. Ventilated term infants with severe meconium inhalation are also at risk of air leak.

Etiology

Alveolar over-distension and rupture results in entry of air into the perivascular, peribronchial and subpleural connective tissue.

Macroscopic appearance
  • Acute pulmonary intersticial emphysema
    • less than 7 days duration
    • air may be seen as a line of bubbles or large blebs on the surface of the lung
    • cut surface of lung with swiss cheese apperance in severe forms
  • Pneumothorax
    • PNO results when air in subpleural connective tissues ruptures into the pleural cavity
    • tension PNO displaces the mediastinum, diaphragm and causes the contralateral lung to collapse
  • Pneumomediastinum and pneumopericardium
    • air in loose connective tissue of mediastinum which is continuous with the connective tissue spaces around the bronchi and pulmonary vessels.
    • pneumopericardium is another serious complication with tamponade like symptoms.
  • Chronic persistent intersticial pulmonary emphysema
    • lasts more than a week
    • localized form  —  multicystic mass involving a single lobe. Treatment consists of surgical resection.
    • diffuse form  —  smaller cysts distributed diffusely through all lobes, signs of severe bronchopulmonary dysplasia are also seen
Pictures

Acute pulmonary intersticial emphysema in premature neonate: Acute interstitial emphysema, Macro, autopsy (73781) Acute interstitial emphysema, Macro, autopsy (73780)

Acute pulmonary intersticial emphysema in premature newborn: Intersticial emphysema, Macro, autopsy (74396)

Chronic pulmonary intersticial emphysema in a single lung lobe. The baby was delivered prematurely at 26 weeks and survived for 7 weeks. Pnemothorax was another complication of barotrauma which occured earlier after birth. Chronic interstitial emphysema, Macro, autopsy (73787) Chronic interstitial emphysema, Macro, autopsy (73788) Chronic interstitial emphysema, Macro, autopsy (73789) Chronic interstitial emphysema, Macro, autopsy (73790)

Chronic interstitial emphysema, immature newborn: Intersticial emphysema, Macro, autopsy (74419) Intersticial emphysema, Macro, autopsy (74420) Intersticial emphysema, Macro, autopsy (74421)

Histology

In chronic emphysema irregular cysts are seen composed of thin to thick fibrous connective tissue wall partially lined by multinucleated foreign body giant cells. The intervening lung parenchyma is collapsed.