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Newborn chest reid
- 1. Newborn Chest Janet R Reid MD, FRCPC Children’s Hospital of Philadelphia Fellow Radiology Lecture Series 2012
- 2. Part I Common Patterns Fellow Radiology Lecture Series 2012
- 3. Ground Glass Clinical Clue: Gestational age: RDS always in premature Xray Clue: Pleural effusion rare in RDS RDS vs Group B Strep infection Fellow Radiology Lecture Series 2012
- 4. Fine Reticular Clinical Clue: History of C-Section in TTN Xray Clue: Cardiomegaly more pronounced in Heart Disease Transient tachypnea vs edema Fellow Radiology Lecture Series 2012
- 5. Coarse Reticular Clinical Clue: Thick meconium at birth; fetal distress Xray Clue: Effusion more common in pneumonia Meconium aspiration vs pneumonia Fellow Radiology Lecture Series 2012
- 6. Mass Clinical Clue: Presence and appearance on prenatal US Xray Clue: Doppler showing systemic vessel Sequestration vs bronchogenic cyst Fellow Radiology Lecture Series 2012
- 7. Multiple Lucencies Clinical Clue: Growth pattern on prenatal US; RDS Xray Clue: Location of stomach bubble Diaphragmatic hernia vs cystic adenomatoid malformation (vs pulmonary interstitial emphysema) Fellow Radiology Lecture Series 2012
- 8. Increased Blood Flow Clinical Clue: Murmur Xray Clue: Distinctness of vessels Intracardiac Shunt vs Edema Fellow Radiology Lecture Series 2012
- 9. Case: Newborn child (3 hours old) with grunting and nasal flaring Fellow Radiology Lecture Series 2012
- 10. Ground Glass Clinical Clue: Gestational age: RDS always in premature Xray Clue: Pleural effusion rare in RDS RDS vs Group B Strep infection Fellow Radiology Lecture Series 2012
- 11. Cases: 2 premature newborns with respiratory distress/same pattern A B Fellow Radiology Lecture Series 2012
- 12. Cases: 2 premature newborns with respiratory distress/same pattern RDS Pneumonia Fellow Radiology Lecture Series 2012
- 13. RDS • Alveolar collapse • Interstitial thickening • Epithelial injury • Bronchiolar distension Fellow Radiology Lecture Series 2012
- 14. RDS • Symmetric ground glass • Air bronchograms • Low lung volumes • NO PLEURAL EFFUSION Fellow Radiology Lecture Series 2012
- 15. Case: Full term newborn admitted to NICU with labored breathing Fellow Radiology Lecture Series 2012
- 16. Coarse Reticular: Differential Diagnosis • Meconium Aspiration • Pneumonia No pleural effusion • Partially treated RDS Full Term • Transient Tachypnea Rarely Fellow Radiology Lecture Series 2012
- 17. Meconium Aspiration • Full term, fetal distress • Bile acids • Small airway inflammation • Thick exudate • Obstruction Fellow Radiology Lecture Series 2012
- 18. Meconium Aspiration • Subsegmental collapse • Compensatory overinflation • Coarse lines • PTX (25%) Fellow Radiology Lecture Series 2012
- 19. Neonatal Pneumonia • Airspace filling • E Coli; Streptococcus; Staphylococcus • No clinical markers • Prolonged rupture of membranes Fellow Radiology Lecture Series 2012
- 20. Neonatal Pneumonia •Patchy asymmetric densities •Hyperinflation •Pleural effusion Fellow Radiology Lecture Series 2012
- 21. Case: Term child born by C Section Fellow Radiology Lecture Series 2012
- 22. Fine Reticular: Differential Diagnosis • Transient tachypnea of the newborn (retained fetal lung liquid) • Pulmonary edema Heart usually bigger • Pneumonia No clinical or radiographic improvement Fellow Radiology Lecture Series 2012
- 23. Transient Tachypnea •Caesarian section •Lack of squeezing of chest during delivery •Fluid in interstitium and airspaces Fellow Radiology Lecture Series 2012
- 24. Transient Tachypnea • Interstitial edema • Possible cardiomegaly • Pleural effusion • Rapid improvement in 24 hours Fellow Radiology Lecture Series 2012
- 25. Cases: 2 preterm children with respiratory distress Fellow Radiology Lecture Series 2012
- 26. Multiple Lucencies: Differential Diagnosis • Congenital Diaphragmatic Mass effect; stomach up Hernia Mass effect; stomach down • Congenital Cystic Adenomatoid Malformation Prematurity; day 3 • Pulmonary ventilation Interstitial Emphysema Fellow Radiology Lecture Series 2012
- 27. Cases: 2 preterm children with respiratory distress CDH PIE Fellow Radiology Lecture Series 2012
- 28. CDH •Foramen of Bochdalek •Failure of mesenchymal induction •Mass effect Fellow Radiology Lecture Series 2012
- 29. CDH • More commonly left-sided • Stomach, intestine, liver, spleen •>35% associated heart disease • Pulmonary hypoplasia • Contralateral lung: prognosis Fellow Radiology Lecture Series 2012
- 30. PIE • RDS, pressure ventilation • “Air block” • Interstitium and lymphatics Fellow Radiology Lecture Series 2012
- 31. PIE • Multiple dark distinct rounded lucencies • Ventilator settings “going up” • Can progress to PTX, pneumomediastinum, pneumoperitoneum, pneumopericardium, parenchyma Fellow Radiology Lecture Series 2012
- 32. Case: Asymptomatic newborn • Chest mass Fellow Radiology Lecture Series 2012
- 33. Mass: Differential Diagnosis • Congenital Diaphragmatic Where is the Hernia stomach? • Diaphragm Possible Eventration • Cystic Adenomatoid Not cystic Malformation • Bronchogenic Cyst Location • Sequestration Possible Fellow Radiology Lecture Series 2012
- 34. Sequestration • Present prenatally • Diagnosis: Doppler or MRI • Systemic arterial supply • Systemic (ELS) or pulmonary (ILS) venous drainage Fellow Radiology Lecture Series 2012
- 35. CCAM/CPAM Fellow Radiology Lecture Series 2012
- 36. Bronchogenic Cyst Fellow Radiology Lecture Series 2012
- 37. Mass: Differentiating Features • Congenital Diaphragmatic Hernia: • Prenatal diagnosis (fetal MRI) • Respiratory distress • High position of the stomach • Diaphragm Eventration: • Cannot differentiate from CDH with imaging • Cystic Adenomatoid Malformation: • Prenatal diagnosis; US; CT • Bronchogenic Cyst: • Usually mediastinal or right-sided parenchymal Fellow Radiology Lecture Series 2012
- 38. Cases: Two full term newborns with tachypnea A B Fellow Radiology Lecture Series 2012
- 39. Cases: Two full term newborns with tachypnea • In edema the vessels are indistinct • With shunt vascularity, they are big and distinct • In both there is usually cardiomegaly Edema Shunt Fellow Radiology Lecture Series 2012
- 40. Part II Additional Patterns Fellow Radiology Lecture Series 2012
- 41. Focal Lucency PNEUMOMEDIASTINUM • Uplifted thymus • Can progress to PTX, pneumoperitoneum, pneumopericardium, parenchyma Fellow Radiology Lecture Series 2012
- 42. Focal Lucency PNEUMOTHORAX PNEUMOTHORAX • Spontaneous or related to ventilation • ALWAYS UNDER TENSION Fellow Radiology Lecture Series 2012
- 43. Small Thorax PULMONARY HYPOPLASIA • Dysplastic, obstructed or absent kidneys • Oligohydramnios leads to pulmonary hypoplasia Fellow Radiology Lecture Series 2012
- 44. Asymmetric Ventilation CHRONIC LUNG DISEASE OF CHRONIC LUNG DISEASE OF PREMATURITY PREMATURITY • Air trapping • Atelectasis • Cysts Fellow Radiology Lecture Series 2012
- 45. Opaque Hemithorax A B Fellow Radiology Lecture Series 2012
- 46. Opaque Hemithorax PULMONARY AGENESIS PULMONARY AGENESIS ATELECTASIS ATELECTASIS • Pleural rind • +/- Air bronchograms • No lung markings • ET tube Pulmonary Agenesis Atelectasis Fellow Radiology Lecture Series 2012
- 47. Summary • There are several common patterns of disease on newborn chest radiographs • One can differentiate between diseases based on clinical and radiographic clues • Important to adopt a differential diagnosis to include 2 “top contenders” for each pattern • Use ultrasound and prenatal MRI in pediatric chest disease Fellow Radiology Lecture Series 2012
- 48. Summary GROUND GLASS FINE RETICULAR COARSE RETICULAR • Gestational age: RDS • History of C-Section • Thick meconium at always in premature in TTN birth; fetal distress • Cardiomegaly more • Effusion more • Pleural effusion rare pronounced in Heart common in in RDS Disease pneumonia RDS vs GBS TTN vs Edema Meconium vs Infection Pneumonia Fellow Radiology Lecture Series 2012
- 49. Summary MASS MULTIPLE LUCENCIES INCREASED FLOW • Presence and • Growth pattern on • Murmur appearance on prenatal US; RDS prenatal US • Doppler showing • Location of stomach • Distinctness of systemic vessel bubble vessels Sequestration vs CDH vs CCAM vs PIE Edema vs L-->R bronchogenic cyst Shunt Fellow Radiology Lecture Series 2012
Notas del editor
- Ask one question- what is the gestational age What is this pattern What is the most helpful associated finding for this diagnosis.
- Ground glass
- What is the pattern: Course reticular
- Pattern- fine reticular
- Pattern: multiple radiolucencies
- Pattern: mass
- Pattern: Increased blood flow
- Which is pulm agenesis and which is atelectasis