Percutaneous evacuation of diffuse pulmonary interstitial emphysema by lung puncture in a baby with extremely low birth weight: a case report

Abstract

IntroductionPulmonary interstitial emphysema is a serious complication of mechanical ventilation and can become life-threatening if progression occurs. Therapeutic lung puncture is a treatment option for severe pulmonary interstitial emphysema but has a limited use in babies with extremely low birth weight. We present a case of pulmonary interstitial emphysema in a Japanese baby (1-day-old) boy with extremely low birth weight. The emphysema was successfully decompressed by therapeutic lung puncture performed with a trocar catheter.Case presentationThe baby was born with a weight of 420g, which, to the best of our knowledge, is the lowest reported birth weight among babies with pulmonary interstitial emphysema. A chest X-ray on postnatal day 2 revealed pulmonary interstitial emphysema, which gradually progressed to diffuse pseudocystic changes. His condition became life-threatening despite the use of high-frequency oscillatory ventilation and lateral decubitus positioning. We evacuated the pulmonary interstitial emphysema by lung puncture with a trocar catheter to avoid respiratory and cardiovascular collapse. This resulted in adequate evacuation of the emphysema and a dramatic improvement in his clinical condition.ConclusionsTherapeutic lung puncture performed with a trocar catheter is beneficial in babies with extremely low birth weight and diffuse pulmonary interstitial emphysema. This treatment option may be broadly applicable, especially in an emergency situation.

Percutaneous Drainage for Giant Pulmonary Interstitial Emphysema in a Tiny Infant with a Birth Weight of 327 g

“…As for the device, we could not clarify but 24-gauge peripheral intravenous catheter might have been used. 14 The infant in our case had considerably smaller weight compared with those previously reported cases of drainage. Further research is required to determine the optimum approach for this procedure in terms of adequate patient's condition, concrete device, and appropriate suction pressure.…”

“…2,[7][8][9][10][11][12] Conversely, there are a few case reports on percutaneous drainage for PIE. 13,14 The cause of PIE is leaked gas trapped in the interstitium from alveoli. 5 Especially, preterm infants have a higher risk of PIE as their perivascular connective tissues are abundant and relatively more compliant.…”

A Case of Pulmonary Interstitial Emphysema Treated by Percutaneous Catheter Insertion in Extremely Low Birth Weight Infant

“…There are a few reports to describe percutaneous catheter insertion as treatment of PIE, especially in ELBW infants. Milligan, et al 15 described that 75% of premature infant with PIE were treated by chest tube insertion, Watanabe, et al 16 reported an ELBW infant (420 g) whose diffuse PIE was evacuated. And Fujii and Moulton 17 reported ELBW infant (533 g) with PIE treated by pigtail catheter insertion into pneumatocele and chest tube to pleural cavity.…”