Pulmonary Interstitial emphysema

  • Etiology: barotrauma from mechanical ventilation in patients with respiratory distress syndrome
  • Imaging: see rupture of alveoli with air leaking into interstitium, lymphatics, venous system
  • DDX: Pulmonary interstitial emphysema vs. airbronchograms of respiratory distress syndrome – both branch but pulmonary interstitial emphysema is thicker + blacker without orderly tapering of air bronchograms
  • Complications: prelude to pneumothorax, often tension pneumothorax

Radiology Cases of Pulmonary Interstitial Emphysema

CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung along with air in the superior mediastinum.
CXR of pneumothorax
Supine CXR shows a large amount of air in the right pleural space with inversion of the right hemidiaphragm and mediastinal shift to the left. There is also evidence of pulmonary interstitial emphysema in the right lung.
CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung.
CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung and a large amount of air in the right pleural space.
AXR of pneumoperitoneum in a patient with respiratory distress syndrome
CXR AP shows a bubbly branching appearance to the right lower lobe and overall increased lucency throughout the entire abdomen.

Gross Pathology Cases of Pulmonary Interstitial Emphysema

Gross pathology image of pulmonary interstitial emphysema
Gross pathological image of the right lung shows bubbles of air throughout the pulmonary interstitium of the lung.