Acquired interstitial emphysema in a premature patient. Treatment with unilateral angioplasty balloon pulmonary blockage.

Abstract

Introduction: Pulmonary interstitial emphysema is a severe rare complication associated with mechanical ventilation in pre-term patients. It induces alterations both in ventilation and pulmonary perfusion, and it may cause progressive overdistension of the side involved and atelectasis of the contralateral lung. Management is uneasy and requires changing ventilation strategies, with invasive procedures such as blockage and selective pulmonary ventilation being potentially necessary.

Clinical case: Premature female patient born at gestation week 26+0, with an initially good clinical progression and baseline chest X-rays showing no signs of congenital pulmonary injury. On day 20 of life, progressive respiratory deterioration was noted. In the series X-rays and chest CT-scan, a right-sided pulmonary interstitial emphysema with mediastinal displacement and left-sided pulmonary atelectasis, associated with hemodynamic and respiratory instability, was observed. On day 26 of life, in light of the poor clinical progression and the immediate threat of death, decision was made to place a right-sided bronchial blocker with a 3x20 mm angioplasty balloon, after the bronchus had been measured through CT-scan. Following placement, respiratory and ventilation parameters improved immediately. The device was kept inflated for 3 days. 10 days after removing the bronchial blocker, the patient was successfully extubated, and she was discharged after 100 days in hospital, with no respiratory symptoms, and the pre-discharge CT-scan showing no signs of emphysema. After 50 months of follow-up, the patient remains asymptomatic from a respiratory standpoint, and psychomotor development is normal.

Discussion: Selective angioplasty balloon pulmonary blockage has been supported by scientific evidence in extremely premature patients with acquired interstitial emphysema associated with compromised ventilation and atelectasis of the contralateral lung. In our case, it helped save the patient's life with not sequelae being caused.