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- W2000644140 abstract "A 26-year-old man was exposed to trichiorosilane and tetrachlorosilane gases after an industrial explosion. These gases are converted to hydrochloric acid on contact with water, thus causing severe chemical bums to mucus membranes. The patient sustamed severe laiyngotracheobronchial injury, documented by bronchoscopy, and corneal bums. He rapidly developed the acute respiratory distress syndrome and required high levels of mechanical ventilatory support, with a 0.80-1.0 fraction of inspired 02, a positive end-expiratory pressure of 24 cm H20, and peak alveolar pressures in excess of 50 cm H70 to maintain adequate gas exchange. Severe barotrauma subsequently developed, including pneumothorax, pneumomediastinum, and severe subcutaneous emphysema. A CT scan as part of an evaluation for nosocomial infection showed palmonary interstitial emphysema (PIE). Discussion PIE is recognized commonly in neonates but rarely in adults. It results from dissection of the pulmonary interstitium by air from ruptured alveoli [I]. Multiple factors are responsible for the development of PIE, including the amount of time spent on ventilators with peak airway pressures greater than 30 cm H20, the clinical severity of the acute respiratory distress syndrome, and associated pulmonary abnormalities [21. Virtually any phenomenon that increases intrapulmonary pressure or lung volume can result in PIE. Chest radiograph findings, which are subtle and often unrecognized, include multiple small and large parenchymal cysts, linear streaks of air extending to the mediastinum, perivascular halos from air collections, intraseptal air, and subpleural cysts [3, 4]. Our experience is that these findings are infrequent even in clinically suggestive cases, likely because of other superimposed radiographic abnormalities such as subcutaneous emphysema and severe acute lung injury. Satoh et al. [5] reported that both perivascular and peribronchial emphysema were CT findings of PIE. In our patient, we saw air within the interlobular septa (Fig. IA) and around the pulmonary veins (Fig. IB). On most occasions, PIE is suspected clinically. The sequelae include decreased ventilation and perfusion due to an overall decrease in lung space. PIE is also a precursor for potentially life-threatening pneumothorax or pneumomediastinum [ 1]. PIE has been reported to be a transient phenomenon [5], although in our patient four serial CT scans showed no change in the appearance or distribution of PIE over 2 1 days." @default.
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- W2000644140 date "1999-06-01" @default.
- W2000644140 modified "2023-09-27" @default.
- W2000644140 title "Pulmonary interstitial emphysema: CT findings." @default.
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- W2000644140 doi "https://doi.org/10.2214/ajr.172.6.10350307" @default.
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