Tuberc Respir Dis.  2008 Feb;64(2):138-143.

A Case of Nonspecific Interstitial Pneumonia Complicated with Spontaneous Pneumomediastinum, Subcutaneous Emphysema and Pneumatosis Interstinalis

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, Kyung Hee University School of Medicine, Seoul, Korea. mjpwis@chol.com

Abstract

Pneumatosis intestinalis or spontaneous pneumomediastinum are rarely associated with nonspecific interstitial pneumonia (NSIP). However, the development of both conditions in the same patient simultaneously has not been reported previously. A 56-year-old man with NSIP developed spontaneous pneumomediastinum accompanied by subcutaneous emphysema and pneumatosis intestinalis after the treatment with intravenous high dose steroid. The development of spontaneous pneumomediastinum, subcutaneous emphysema and pneumatosis intestinalis in this patient was possibly due to the factors such as NSIP, high dose steroid therapy and subclinical dermatomyositis. Treatment with corticosteroid and cyclosporin gradually improved his exacerbated NSIP and pneumomediastinum, subcutaneous emphysema, pneumatosis intestinalis.

Keyword

Nonspecific interstitial pneumonia; Pneumatosis intestinalis; Pneumomediastinum

MeSH Terms

Cyclosporine
Dermatomyositis
Humans
Lung Diseases, Interstitial
Mediastinal Emphysema
Middle Aged
Subcutaneous Emphysema
Cyclosporine

Figure

  • Figure 1 (A) Chest X-ray shows pneumonic consolidation on right lower lobe and suspicious faint nodular opacities on both lungs. (B) Chest CT shows irregular patchy airspace consolidation on peripheral portion of both lower lobes.

  • Figure 2 Pathologic finding shows mixed cellular and fibrotic NSIP. The uniform distribution is characteristic of both cellular and fibrotic NSIP (H&E stain, ×100).

  • Figure 3 (A) Chest X-ray shows diffusely increased ground glass opacity on both lungs. (B) HRCT shows the aggravation of irregular patchy airspace consolidation, multiple ground glass opacities and reticular opacities on the peripheral portion.

  • Figure 4 (A) Neck AP shows mediastinal and subcutaneous emphysema. (B) HRCT shows the mediastinal emphysema with multiple patchy densities on both upper lobes. (C) Colonoscopy shows multiple submucosal cystic lesions (air bubble) of distal colon.

  • Figure 5 (A) Chest X-ray shows focal fibrotic opacities on right lower lobe and marked improvement of ground glass opacity on both lungs. (B) Chest CT taken (4 months after steroid pulse therapy) shows small reticular opacities on peripheral portion of right lower lobe.


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