Category: Chest

Premature newborn with respiratory distress

CXR of respiratory distress syndrome with symmetrical distribution of artificial surfactant
Initial CXR AP (left) shows low lung volumes and symmetrical ground glass opacity in both lungs. CXR AP obtained 4 hours after the administration of artificial surfactant (right) shows increased lung expansion and clearing of the previously seen ground glass opacity in both lungs.

The diagnosis was respiratory distress syndrome showing the appearance of the chest before and after the symmetrical administration of artificial surfactant.

Premature newborn with respiratory distress

CXR of respiratory distress syndrome with symmetrical distribution of artificial surfactant in the lungs
Initial CXR AP (left) shows low lung volumes and symmetrical ground glass opacity in both lungs. CXR AP obtained 1 hour after the administration of artificial surfactant (right) shows increased lung expansion and clearing of the previously seen ground glass opacity in both lungs.

The diagnosis was respiratory distress syndrome showing the appearance of the chest before and after the symmetrical administration of artificial surfactant.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema causing tension pneumothorax
CXR AP (left) shows bilaterally hyperexpanded lungs with multiple circular bubbly and branching interstitial lucencies bilaterally which appear to radiate from the hila. CXR AP obtained 1 day later (right) shows a large amount of air in the left pleural space causing mediastinal shift to the right and depression of the left hemidiaphragm resulting in a left-sided deep-sulcus sign.

The diagnosis was bilateral pulmonary interstitial emphysema causing a left tension pneumothorax.

Newborn with respiratory distress

CXR of transient tachypnea of the newborn
CXR AP on the first day of life (left) shows normal lung volumes with prominent interstitial infiltrates bilaterally in the lungs and a small right pleural effusion with fluid in the minor fissure of the right lung. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates with a small amount of pleural effusion remaining in the minor fissure of the right lung.

The diagnosis was transient tachypnea of the newborn.

Infant on venous-venous extracorporeal membrane oxygenation after cardiac surgery with new bilateral pleural effusions

US of hemothorax as a complication of extracorporeal membrane oxygenation
CXR AP (above) shows correct position of the ECMO venous-venous catheter tip near the junction of the right atrium and the inferior vena cava. There are bilateral pleural effusions most prominently seen in the apex of the lungs. Transverse US of the right hemithorax (below left) shows echogenic pleural fluid lateral to the atelectatic right lower lobe. Sagittal US of the left hemithorax (below right) shows echogenic pleural fluid inferior to the atelectatic left lower lobe and superior to the spleen.

The diagnosis was correct position of the venous-venous ECMO catheter and bilateral hemothorax as a complication of extracorporeal membrane oxygenation.

School ager post intubation

CXR of endotracheal tube in left mainstem bronchus
CXR AP (left) shows the tip of the endotracheal tube projecting over the left mainstem bronchus. CXR AP (middle) shows the tip of the endotracheal tube projecting over the right mainstem bronchus. CXR AP (right) shows the tip of the endotracheal tube projecting above the carina.

The diagnosis was endotracheal tube malfunction with the endotracheal tube placed initially in the left mainstem bronchus, then in the right mainstem bronchus and finally in the trachea above the carina.

School ager status post left chest tube placement with bloody output from the chest tube and a decreased hematocrit after chest tube placement

CT of chest tube puncturing an intercostal blood vessel causing active bleeding
Arterial (above) and venous (below) phase axial CT with contrast of the chest shows a large hematoma inside the ribs at the chest tube insertion site. There is also a blush of contrast near the chest tube that increases on delayed imaging representing active bleeding.

The diagnosis was a chest tube malfunction in the form of a chest tube puncturing an intercostal blood vessel causing active bleeding.

Teenager with recurrent fevers

CT of pulmonary tuberculosis
Axial CT with contrast of the chest (above) shows a small thick-walled cavitary lesion in the left upper lobe along with some associated opacities peripheral to it as well as in the right upper lobe. MIP axial CT with contrast of the chest (below) shows the entire left lower lobe to be filled with tree-in-bud opacities. There is also a nodular opacity in the anterior right lung.

The diagnosis was tuberculosis pneumonia.

Preschooler with recurrent episodes of respiratory distress over several years

CXR of chronic granulomatous disease
Initial CXR AP (above) shows an opacity in the medial aspect of the right lower lobe which took a year to resolve radiographically. CXR AP obtained 2 years after the initial CXR (below left) shows a dense opacity in the medial aspect of the right upper lobe which was only slightly reduced in size on a CXR obtained a year later (below right).

The diagnosis was chronic granulomatous disease.