Bullous Pneumopathy (Pathophysiology/Differential Diagnosis RDS)

atno_9a_n.jpg: Chest radiograph of a newborn with respiratory distress syndrome; two large, bright and rounded lesions with a dark border in the lower left hemithorax are visible. It is a bullous pneumopathy following pneumonia caused by staphylococci in the newborn and young infant as an example of the two pathophysiological mechanisms, 'valve mechanism of the bronchial system' and 'compression of the lung'. Due to a destruction of lung tissue, cavities result which are filled with air and supported by a bronchiole with a valve mechanism; therefore, these cavities become larger and larger, leading to compression of the adjacent lung tissue. Or, they may lead to pneumothorax by spontaneous perforation, and clinically to a respiratory distress syndrome or other signs of the respiratory system. In case of progressive enlargement of the cyst(s) and of corresponding clinical signs, thoracotomy is indicated with the purpose to open the cyst by unroofing, to ligate the feeding bronchiolus, and to take in the adjacent lung tissue (endorrhaphy). atno_9b_n.jpg: Operative findings in the same patient. The cystic, homogeneous tissue corresponds to several cystic cavities (so-called bullas) which come to the surface of the lung and displace the normal lunge tissue to the side. atno_9c_n.jpg: The cystic cavities have been opened, and the bronchiole draining the cavities (marked with a catheter) will be ligated and the cavities closed with sutures from the depth to surface like a tobacoo pouch.