Pathology
Images
Atlas of Neonatal Pathology
Marta Ježová, Josef Feit
Index
Contents
Authors
Up
Next
Back
×
+ Introduction
+ Using this atlas
+ Conditions of using this atlas
+ Technical notes
+ Hardware
+ Software
+ How to use the atlas
+ Navigating through the text pages
+ Controlling the pictures
+ Logos and labels
+ What will you need to use the atlas
+ Bugs, problems
+ Netscape
+ Microsoft Internet Explorer
+ Some other Internet resources concerning dermatopathology and pathology
+ Support
+ Support
+ Neonatal pathology
+ Basic terms and classification of newborn infants
+ The Apgar score
+ Classification of newborn infants by weight and gestation
+ Pathology of gestation length
+ Prematurity
+ Postmaturity (Clifford syndrome)
+ Growth and developement
+ Intrauterine growth retardation (IUGR), small for gestational age infant (SGA)
+ Large for gestational age infant (LGA)
+ Physical maturity
+ Pathology of prematurity
+ Gross appearance of premature infant
+ Difficulties in maintaining homeostasis
+ Thermoregulation
+ Hypoglycemia
+ Hyperbilirubinemia
+ Fluids and electrolytes
+ Apnea of prematurity
+ Anemia of prematurity
+ Hyaline membrane disease (HMD)
+ Necrotizing enterocolitis (NEC)
+ Intraventricular hemorrhage (IVH)
+ Periventricular leukomalacia (PVL)
+ Patent ductus arteriosus (PDA)
+ Iatrogenic diseases and damage
+ Respiratory system
+ Injuries caused by endotracheal intubation
+ Pulmonary air leak
+ Bronchopulmonary dysplasia (BPD)
+ Retinopathy of prematurity (ROP)
+ Cardiovascular system
+ Total parenteral nutrition associated hepatic damage
+ Infections
+ Viability, survivability and long term sequelae of prematurity
+ Viability
+ Survivability in prematurity
+ Severe long term sequelae in babies born prematurely
+ Birth asphyxia
+ Hypoxic-ischemic encephalopathy (HIE)
+ Meconium aspiration syndrome (MAS)
+ Persistent pulmonary hypertension of the newborn (persistent fetal circulation)
+ Birth trauma
+ Extracranial lesions
+ Soft tissus injuries
+ Intraabdominal injuries
+ Peripheral and cranial nerve injuries
+ Bone injuries
+ Cranial trauma
+ Perinatal infection
+ Intrauterine infections (TORCH group)
+ Sepsis neonatorum
+ Blenorrhea neonatorum
+ HIV infection
+ Stillbirth and perinatal mortality
+ Stillbirth
+ Perinatal mortality
+ Neonatal pathology nonrelated to prematurity, birth asphyxia or infection
+ Congenital anomalies in liveborn infants
+ Kernicterus
+ Hemorrhagic disease of the newborn
+ Spontenous gastric perforation in a neonate
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.