CXR AP (above) shows the arterial catheter tip projecting over the aortic arch and the venous catheter tip projecting over the right atrium. There is bilateral diffuse airspace disease and bilateral pleural effusions. A cystic lesion is seen in the right lower lobe. Axial CT without contrast of the chest (below left) shows the cystic lesion is thin walled and communicates with the bronchial tree and has multiple septations (below right).
The diagnosis was pneumatocele due to pneumococcal pneumonia in a patient on ECMO.
Pediatric Imaging 