Clinical Presentation

A premature newborn on a ventilator.

Frontal chest radiograph demonstrates extensive linear and bubble-like lucencies throughout both lungs that radiate from the hila to the periphery.

Differential Diagnosis

• Pulmonary interstitial emphysema (PIE): Bubble-like or linear lucencies that radiate from the hila in a premature infant on a ventilator are consistent with PIE.

• Partially treated surfactant deficiency disease (SDD): This can be difficult to differentiate from PIE. When SDD is treated with surfactant, there may be re-expansion of some alveoli, but not others, in a pattern that mimics PIE. It is helpful to know when surfactant was administered.