Interstitial Pulmonary Emphysema
Larissa V. Furtado, MD
Angelica R. Putnam, MD
Key Facts
Clinical Issues
Most commonly occurs in premature infants with respiratory distress syndrome treated with assisted ventilated
Interstitial pulmonary emphysema can be acute (< 7 days duration) or chronic (persistent)
In terms of distribution, interstitial pulmonary emphysema may be
Confined to 1 lobe: Localized interstitial pulmonary emphysema
Diffusely distributed through all lobes: Diffuse interstitial pulmonary emphysema
Microscopic Pathology
Variable degree of cystic alveolar dilation
Cysts are lined by compressed lung parenchyma
Cyst walls commonly show variable degree of fibrosis and multinucleated giant cell reaction
 Gross photograph of a localized interstitial emphysema shows numerous variably sized uni-  and multiloculated  air cystic spaces confined to the upper right lobe of the lung parenchyma. |
 Diffuse interstitial emphysema shows single  and intercommunicating cysts  diffusely distributed throughout the lung. The cyst linings are smooth. Cysts are separated by thin and coarse septae. |
ETIOLOGY/PATHOGENESIS
Etiology
Caused by increased intraalveolar pressure
Aspiration of foreign material (e.g., meconium)
Partial occlusion of bronchi or bronchioles
Pulmonary hypoplasia
Frequent complication of high-pressure-assisted mechanical ventilation
May arise spontaneously without any respiratory complication
Pathogenesis
Increased alveolar pressure leads to alveolar rupture and air leakage with dissection into perivascular sheath and subsequent interstitial pulmonary emphysema
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