Neonatal Chest imaging
Neonatal Chest imaging
Respiratory distress syndrome (RDS)
- Diffuse ground-glass appearance ("whiteout") with air bronchograms.
- Decreased lung volumes.
- Bilateral, symmetrical opacities.
- Absence of other findings (e.g., consolidation).
Chronic Lung Disease of Prematurity (CLD) / Bronchopulmonary Dysplasia
- Chronic lung disease primarily affecting premature infants who required mechanical ventilation or oxygen therapy.
- Hyperinflation with increased lung volumes.
- Peribronchial cuffing or thickening.
- Patchy opacities or scarring.
- May have features of interstitial lung disease.
Transient Tachypnea of the Newborn
- Result of delayed clearance of fetal lung fluid, common in term or near-term infants.
- Hyperinflation with fluid in the interlobar fissures ("wet lung").
- Perihilar streakiness or mild opacities.
- Increased lung volumes without consolidation.
- Typically resolves within 24-72 hours.
Neonatal Pneumonia
- Caused by bacterial, viral, or fungal infections acquired during or after birth.
- Patchy, asymmetric opacities.
- Consolidation with air bronchograms.
- Possible pleural effusion or abscess.
- May present with lobar or segmental involvement.
Meconium Aspiration Syndrome (MAS)
- Occurs when meconium is aspirated into the lungs, leading to airway obstruction and inflammation.
- Patchy, asymmetric opacities.
- Atelectasis, hyperinflation, or both.
- Possible air-trapping, pneumothorax, or pneumomediastinum.
- May have coarse streaky infiltrates.
Pulmonary interstitial emphysema
almost always associated with mechanical ventilation or continuous positive airway pressure in the first weeks of life
- Air dissects along the bronchovascular sheaths into the pulmonary interstitium.
- Radiolucent streaks in the periphery of lungs.
- Air trapping with cystic lucencies.
- May evolve into pneumomediastinum or pneumothorax.
- Typically seen in premature infants on mechanical ventilation.
- Fine granular pattern in premature
Respiratory distress syndrome
- Radiating Linear Opacities
Transient Tachypnea of the Newborn
- Course Linear Opacities
Meconium Aspiration and Chronic Lung Disease of Prematurity
- Asymmetric Opacities
Meconium Aspiration and Neonatal Pneumonia
- Focal Opacity
Neonatal Pneumonia, Post Surfactant Therapy and Diaphragmatic Hernia
Abdominal Radiographs
Meconium Peritonitis
Meconium Ileus
Jejunal Atresia
Congenital small bowel obstruction with a microcolon has a limited differential, including jejunoileal atresia and meconium ileus.
With meconium ileus, however, you would expect to see contrast refluxed into dilated small bowel loops containing meconium filling defects.
Calcifications overlying the liver surface are a typical appearance for meconium peritonitis in the neonate.
Umbilical Arterial & Venous Catheters
Umbilical venous catheters: can be distinguished from an umbilical arterial catheter as the umbilical venous catheter travels cranially in the umbilical vein while the umbilical arterial catheter travels caudally in an umbilical artery to reach a common iliac vessel
* Report UAC based on vertebral body level.
* Report UVC based on distance from cavoatrial junction.
Umbilical venous catheter (right side)
Umbilical arterial catheter (midline)
Umbilical Venous Catheter
Umbilical catheter position is critical to assess on each radiograph. An umbilical venous catheter (UVC) should course into the umbilical stump → umbilical vein → left portal vein (LPV) → ductus venosus → middle or left hepatic vein → inferior vena cava (IVC)/right atrium (RA).
If it enters the superior vena cava (SVC), RA, the pulmonary outflow tract, portal venous system, or superior mesenteric vein, complications such as arrhythmia, thrombus or emboli formation, or end-organ injury may occur, as did here.
The tip should lie at the junction of the inferior vena cava with the right atrium.
Umbilical arterial catheter (midline)
Umbilical venous catheter (right side)
Umbilical Arterial Catheter
The catheter should pass through the umbilicus, travel inferiorly through the umbilical artery, then in the anterior division of the internal iliac artery, into the common iliac artery and then into the aorta. It is essential to ensure that the tip of the catheter is not in a branch of the aorta (where it could block the vessel or instill a high concentration solution directly into an organ-feeding vessel, such as the renal artery).
The tip of the catheter should thus be placed in one of two locations:
high position: at T6 to T10 level
low position: at L3 to L5 level
Intermediate positions are generally undesirable due to potential associated thromboses of major aortic branches between T10 to L3.