Newborn immediately status post repair of left congenital diaphragmatic hernia

CXR of hypoplastic lung bud postoperatively in congenital diaphragmatic hernia
CXR AP (left) shows the hypoplastic lung bud which cannot immediately expand to fill the hemithorax in the apex of the left hemithorax and therefore there is also air in the left pleural space. Note that this is not a pneumothorax and should not be drained via a chest tube. CXR AP obtained 2 days later (right) shows the left pleural space is now filled with fluid rather than air, and again this should not be drained by a chest tube. As the lung bud expands, the pleural effusion will decrease in size.

The diagnosis was development of a left pleural effusion to fill the potential space in the left hemithorax after repair of a left congenital diaphragmatic hernia.

Infant who had undergone emergency thoracotomy for cardiac massage during a cardiac arrest 6 months before and now has a lump under the left arm

CXR of pulmonary herniation
CXR AP in inspiration (above) shows the left 5th intercostal space at the side of the previous thoracotomy to be deformed. CXR AP in expiration (below) shows interval development of a cystic structure in the soft tissues of the left chest wall.

The diagnosis was pulmonary herniation through the left 5th intercostal space secondary to incorrectly repaired thoracotomy incision.

Infant with respiratory distress

CXR and bronchogram and pulmonary angiogram of pulmonary agenesis
CXR AP and lateral (above) shows complete opacification of the left hemithorax and tracheal and mediastinal shift to the left and hyperexpansion of the right lung. CXR AP taken during a bronchogram (below left) shows absence of the left mainstem bronchus. AP image from a pulmonary angiogram (below right) shows a normal appearing right main pulmonary artery and absence of the left pulmonary artery.

The diagnosis was pulmonary agenesis.

School ager with cough and fever

CXR of bronchial atresia
Inspiratory CXR AP (upper left) shows increased lucency in the left upper lobe when compared to the right upper lobe while expiratory CXR AP (upper right) shows air trapping in the left upper lobe. Magnified view of the upper lobes (below) better shows a round lesion in the lower portion of the left upper lobe which represents mucous trapped distally to an area of atresia in a bronchus.

The diagnosis was bronchial atresia.