Author: Pediatric Imaging

Newborn after repair of a left-sided congenital diaphragmatic hernia

CXR after congenital diaphragmatic hernia repair showing no need for a chest tube
CXR AP (above) taken immediately postop shows that the hypoplastic left lung cannot expand to completely fill the pleural space particularly in the basilar region and subsequently there is a moderate amount of air in the pleural space. This should not be called a pneumothorax. CXR AP taken 1 day later (below) shows the left pleural space now filling with fluid.

The diagnosis was normal post-operative appearance after congenital diaphragmatic hernia repair.

Young adult with cystic fibrosis with continued shortness of breath after chest tube placement

CXR of chest tube malposition with chest tube in the lung parenchyma
CXR AP (left) shows chronic interstitial fibrosis and scarring in the lungs, a left-sided chest tube, and a moderately-sized basilar left pleural air collection manifesting as a deep sulcus sign. Gross pathological specimen (right) shows the left chest tube entering the upper lobe of the left lung.

The diagnosis was persistent pneumothorax in a patient with cystic fibrosis due to the chest tube tip not being in the pleural space.

Teenager in motor vehicle accident with continued shortness of breath after chest tube placement

CT of chest tube malposition with chest tube in the lung parenchyma
Axial and coronal and sagittal CT with contrast of the chest shows a large amount of air in the left pleural space. The left chest tube is clearly located within the air space disease in the posterior left lung parenchyma in all three planes.

The diagnosis was persistent pneumothorax in a thoracic trauma patient with pulmonary contusion due to the chest tube tip not being in the pleural space.

Premature newborn after chest tube placement

CXR of chest tube malfunction with chest tube in the subcutaneous tissues of the chest wall
CXR AP shows diffuse ground glass opacity throughout the lungs and a large amount of air in the right pleural space causing mediastinal shift to the left while the right-sided chest tube courses through the subcutaneous tissues of the right chest wall and never enters the right pleural space.

The diagnosis was persistent pneumothorax in a patient with respiratory distress syndrome due to the chest tube tip not being in the pleural space.

Infant who was on arterial-venous ECMO post cardiac arrest and has just been taken off of ECMO

CT of intraventricular hemorrhage, intracerebral hemorrhage, and cerebral atrophy in a patient on extracorporeal membrane oxygenation (ECMO)
Axial CT without contrast of the brain shows mixed-density fluid in the left lateral ventricle posteriorly and mixed-density fluid in the left parietal-occipital lobe. There is also diffuse prominence of the sulci and ventricular system.

The diagnosis was intraventricular hemorrhage on ECMO and intracerebral hemorrhage on ECMO and cerebral atrophy post ECMO.

Newborn with a left congenital diaphragmatic hernia on arterial-venous (AV) ECMO

CXR of arterial-venous extracorporeal membrane oxygenation (ECMO)
CXR shows normal position of the arterial catheter tip in the aortic arch and normal position of the venous catheter tip in the right atrium, both of which are shifted to the right by the diaphragmatic hernia. Note that the endotracheal tube, which is positioned between the two ECMO catheters, is also shifted to the right.

The diagnosis was normal position of the AV ECMO catheter tips in a neonate.