Spontaneous Diffuse Pulmonary Interstitial Emphysema (PIE) in an unventilated infant

Pulmonary Interstitial Emphysema (PIE) is a well documented complication of mechanical ventilation, but it also seen in unventilated premature babies. When an apparently healthy, near-term 2 week old infant suddenly developed respiratory distress, PIE was excluded clinically, despite the characteristic honeycomb appearance of the lungs on chest X-ray. However, rare cases of term unventilated babies with PIE are reported in the literature and this was later found to be the underlying diagnosis. This case is reported to highlight the challenges and complexities of routine medical practice, as well as the need for clinicians to keep in mind rarer differential diagnoses like PIE in a healthy term baby.