CTICasesPulmonary Interstitial Emphysema
Imaging findings
Frontal chest radiograph in a trauma patient on ECMO demonstrates severe diffuse consolidation and prominent, linear branching lucencies resembling "black curly lines" or lightning bolts. CT confirms extensive pulmonary interstitial emphysema with gas tracking along the bronchovascular bundles, interlobular septa, major fissures, and inferior pulmonary ligaments, accompanied by pneumomediastinum.
Key takeaways
Pulmonary interstitial emphysema (PIE) occurs when alveolar rupture allows gas to escape into the interstitial tissues of the lung, typically due to barotrauma from positive-pressure mechanical ventilation in patients with severe lung injury or ARDS. Radiographically, it manifests as branching, linear lucencies (the reverse of air bronchograms) that track anatomically along the interstitium and pulmonary ligaments.
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