Neonatal CXR's
RDS| MAS| BPD|
NEC|
Tension Pneumthorax|
Pneumomediastinum|
Diaphragmatic
Hernia| Esophageal Intubation
Respiratory Distress Syndrome (RDS)
CXR:
Due to underlying surfactant deficiency stemming from prematurity, there
is diffuse bilateral reticular granular densities
and microatelectasis. Common descriptions include Ground glass
appearance, Salt and Pepper appearance. The underlying
lung disease results in reduced lung volume.
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Meconium Aspiration Syndrome: (MAS)
Due to aspiration of meconium into the trachea
and airways. Can result in a chemical pneumonitis and obstruction
of peripheral airways
due to the thick meconium. This obstruction of
airways can result in a ball valve effect which may result in
hyperinflation and pneumothorax.
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Bronchopulmonary Dysplasia:
(BPD)
Produced by an inflammatory response due to
volutrauma and high 02 concentrations. Air cysts surrounding dense
patches
(alveolar collapse, edema, fibrosis of the interstitium).
There are 4 stages of BPD. CXR is similar to multifocal emphysema.
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Necrotizing Enterocolitis: (NEC)
Results in pneumotosis (air in the wall of
the bowel) and perforation. Perforation is due to ischemic necrosis
as a result of impaired
blood flow to the bowel. Air the portal
system is an ominous sign of NEC.
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Tension Pneumothorax:
Results when intrapleural pressure is greater than
atmospheric during expiration and often inspiration. Caused by disruption
of visceral or parietal pleura which results
in a one way valve effect. The end result is a reduced vital capacity
and Pa02. Can be caused by mechanical ventilation.
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Bilateral Tension Pneumthorax 
Pneumomediastinum:
When air dissects out of alveoli and into the anterior
mediastinum. Collections of mediastinal air are often seen surrounding
the left
heart border. Also you my see the classic
"sail sign" or air around the thymus.
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CXR 
Diaphragmatic Hernia:
When the abdominal contents of the infant migrate
up through a hernia in the diaphragm. These contents impede on the
heart and lungs.
Do not Bag and Mask these patients due to
gastric distention. These patients upon delivery have a flattened
abdomen
and barrel chest.
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Esophageal Intubation:
Results in Endotracheal tube in the stomach.
Will see large gastric bubble and atelectatic lungs.
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I would like to thank Kim Simmons MHS, RRT for use of her collection
of CXR's that made this site possible.
Kay Givens