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We're going to talk about a couple of entities

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that can occur in patients who have underlying SDD

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that show up as lucencies on chest radiographs.

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This first case is the same patient

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as the patient in the first case.

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In the last section where I discussed SDD,

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so this is the 25 week gestational age baby,

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but a couple months later, as you can see,

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their lung pattern has changed.

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So rather than those hazy

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and granular pulmonary opacities

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that we saw in the first day

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of life, now we have a different picture.

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We see hyper expanded lungs

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and we see diffuse coarse interstitial thickening

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with innumerable tiny little lucencies In between

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those lucencies with the surrounding interstitial thickening

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are typical findings for broncho pulmonary dysplasia,

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also known as chronic lung disease of the newborn.

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This occurs several weeks

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after the baby is born with surfactant deficiency disease

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and is sort of the end result of the lung damage

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that occurs as a result.

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By definition, bronchopulmonary dysplasia cannot occur

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before about a month of age,

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and this is important to know when we discuss our next

1:15

entity because the imaging findings can be quite similar.

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Note that this patient additionally has some asymmetric,

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patchy and streaky opacities,

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namely in the right upper lobe,

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which is superimposed atelectasis.

1:30

The next case is the same as the second patient

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that I showed in the SDD section,

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and this baby has a couple different things going on,

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so this baby is still only about a week or so old,

1:45

and we can see that on their right side.

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We still have that hazy

1:48

and granular appearance of surfactant deficiency disease,

1:51

a milder case,

1:53

but we can see on the left side

1:54

that it has a different appearance.

1:56

Again, we have a very similar kind of appearance as

1:59

what I just showed with the bronchopulmonary dysplasia

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where we see thickened coarsened, linear opacities

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with intervening tiny little round lucencies.

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But in this case, although the pattern is similar,

2:11

this is a different entity.

2:13

This is pulmonary interstitial emphysema,

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and this is a form of air leak that can happen in patients

2:19

who have underlying SDD where air escapes

2:23

through the interstitium of the lungs

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and causes this appearance.

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It can have a branching appearance if you're looking at it

2:30

lengthwise or punctate cent, little round

2:34

foci if you're looking at them.

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End on. Although this appearance can look very similar

2:39

to bronchopulmonary dysplasia,

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a really important distinguishing feature is that patients

2:44

with PIE pulmonary interstitial emphysema are going

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to be less than four weeks old, whereas those

2:50

with bronchopulmonary dysplasia will be

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older than four weeks old.

2:54

PIE can happen as a result of barrow trauma for mechanical

2:58

Ventilation and for the same reason they're also at risk

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for pneumothorax or PNE mediastinum.

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When you see PIE, that also is a risk

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for future pneumothorax or pum mediastinum.

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The last case I'll show you here is also the same

3:16

as the third patient I showed in the SDD section

3:19

and similar to the second case, we can see

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that there's an SDD pattern in the right lung

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with the hazy granular opacities,

3:27

but we have these mixed lucencies

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and thickened interstitial markings on the left,

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and this patient is only a day old,

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so this is gonna be pulmonary

3:37

interstitial emphysema as well.

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What I want to note in this patient is that

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a short time later you can see

3:45

that their chest radiograph has improved.

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They no longer are requiring an endotracheal tube,

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and we can see both that the

3:53

SDD pattern on the right looks improved

3:55

and the PIE pattern on the left also looks improved.