0:00

So this was a two week old infant who had lung disease

0:04

of prematurity and is continuing to be, uh, uh, intubated

0:08

with, uh, respiratory support.

0:11

Um, this patient does have a left upper extremity pick

0:14

peripherally inserted central catheter that extends

0:16

to the upper right atrium level.

0:18

And he has an tube

0:20

with the tip appropriately projecting over the stomach.

0:23

So I think this finding is challenging

0:25

to tell is it the opacities that are the abnormal finding

0:29

or is it the lucencies that are the abnormal finding?

0:32

And of course the answer is both

0:33

because this patient has lung disease

0:34

and prematurity with atelectasis.

0:36

Right? We have some increased density in our left retro

0:39

cardiac region, but check out these branching, um, kind

0:43

of linear and branching lucencies,

0:46

not only diffusely throughout the right lung,

0:48

but extending through the upper, uh, left upper

0:51

and mid lung zones as well on the other side.

0:54

So once I see branching lucencies like this,

0:57

I'm concerned about a complication

0:58

of lung disease and prematurity.

1:00

Um, and that's pulmonary interstitial emphysema.

1:04

So this patient had a CT for other reasons,

1:07

but it nicely illustrates the appearance

1:09

of pulmonary interstitial emphysema

1:11

and it nicely correlates with that radiograph.

1:13

So we see these, uh, branching

1:17

lucencies extending diffusely throughout the interstitial

1:20

all throughout the right lung.

1:22

Um, these loosen lines

1:24

and branching, um, lucencies, uh,

1:27

parallel the bronchovascular bundles diffusely throughout

1:30

the right lung and as well we see them um, in the right, uh,

1:33

left, left upper and mid lung zone.

1:36

I will show you on an axial as well.

1:39

Um, this is a non-contrast chest ct.

1:41

Now we're in the axial plane

1:43

where you can see these loosened lines

1:46

and branching structures going all along the interstem

1:49

of the, uh, bronchovascular bundles.

1:52

So this is a gorgeous CT example

1:55

of pulmonary interstitial emphysema.

1:57

A nice correlate to that CT appearance that we saw.

2:00

But no pneumothorax, no pneumo, media signum.

2:03

And this is what lung disease

2:04

of prematurity looks like on CT with this sort

2:07

of ground glass opacification or attenuation of the lungs.

2:10

Diffusely. Um,

2:12

this is just some asymmetric right-sided PIE

2:16

with less left-sided PIE.