History and Physical Examination

History

Pulmonary interstitial emphysema (PIE) is a radiographic and pathologic diagnosis. PIE is associated with few clinical signs, but a progressive, sometimes rapid, increase in oxygen (O₂) requirements, carbon dioxide (CO₂) retention or hypotension are suggestive of this diagnosis.

Alternatively, the infant can present with the signs of one of the complications of PIE, such as pneumothorax. Occasionally, PIE becomes apparent following reexpansion of a collapsed lung after drainage of a pneumothorax.

Physical examination

No specific signs of PIE are reported. There may be overinflation of the chest wall and crepitations on auscultation on the affected side. A characteristic sound of crushing styrofoam or walking on dry snow signals PIE.

Differential Diagnoses

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Media Gallery

This radiograph, obtained from a 1-day-old premature infant at 24 weeks' gestation, shows bilateral pulmonary interstitial emphysema (PIE). Linear radiolucencies extending up to the lung periphery are visible.
This radiograph, obtained from a premature infant at 26 weeks' gestation, shows characteristic radiographic changes of pulmonary interstitial emphysema (PIE) of the right lung.
This radiograph shows pneumothorax and pulmonary interstitial emphysema (PIE) on the right side. Interstitial air prevents collapse of the underlying lung by a tension pneumothorax. In such cases, extreme caution is required during drainage of a pneumothorax to avoid perforation of the underlying lung.

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Author

Abhay J Bhatt, MD, MBBS Professor, Department of Pediatrics, Division of Neonatology, Clinical Science Director, Center for Developmental Disorders Research, University of Mississippi Medical Center

Abhay J Bhatt, MD, MBBS is a member of the following medical societies: Society for Pediatric Research

Disclosure: Nothing to disclose.

Coauthor(s)

Rita M Ryan, MD Chair and Professor, Department of Pediatrics, Medical University of South Carolina College of Medicine; Pediatrician-in-Chief, Division of Neonatology, MUSC Children's Hospital

Rita M Ryan, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, American Physiological Society, American Thoracic Society, Irish and American Paediatric Society, Perinatal Research Society, Society for Pediatric Research, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Jagdish Desai, MD, MPH Assistant Professor of Pediatrics, Neonatologist, University of Mississippi Medical Center

Jagdish Desai, MD, MPH is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, Brooklyn Pediatric Society, Midwest Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Brian S Carter, MD, FAAP Professor of Pediatrics, University of Missouri-Kansas City School of Medicine; Attending Physician, Division of Neonatology, Children's Mercy Hospital and Clinics; Faculty, Children's Mercy Bioethics Center

Brian S Carter, MD, FAAP is a member of the following medical societies: Alpha Omega Alpha, American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Pediatric Society, American Society for Bioethics and Humanities, American Society of Law, Medicine & Ethics, Society for Pediatric Research, National Hospice and Palliative Care Organization

Disclosure: Nothing to disclose.

Chief Editor

Muhammad Aslam, MD Professor of Pediatrics, University of California, Irvine, School of Medicine; Neonatologist, Division of Newborn Medicine, Department of Pediatrics, UC Irvine Medical Center

Muhammad Aslam, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.