School ager with cough and fever

CXR of bacterial pneumonia in the lingula — CXR PA (left) shows an opacity in the left mid lung that is obscuring the left heart border while on the CXR lateral (right) the opacity is seen to overlie the heart.

The diagnosis was bacterial pneumonia in the lingula.

Toddler with sickle cell disease and fever

CXR of bacterial pneumonia in right upper lobe — CXR PA (left) shows an opacity in the right upper lobe which on the CXR lateral (right) is seen to be located posteriorly causing a spine sign.

The diagnosis was bacterial pneumonia in the posterior segment of the right upper lobe in a patient with sickle cell disease. The organism was bacillus non-anthrax.

Teenager with fever and hemoptysis

CXR and CT of bacterial pneumonia in the left lower lobe — CXR PA (above left) shows an opacity in the medial left lower lobe that obscures the medial left hemidiaphragm. CXR lateral (above right) shows a spine sign over the lower thoracic vertebral bodies. Axial CT without contrast of the chest (below left) shows a dense infiltrate in the posterior aspect of the left lower lobe while the sagittal CT (below right) again shows the infiltrate to be located inferiorly and posteriorly in the chest.

The diagnosis was bacterial pneumonia in the posterior left lower lobe.

School ager with upper respiratory infection and decreased right breath sounds

CXR of bacterial pneumonia of right middle lobe — CXR PA (left) shows a dense opacity in the middle of the right lung that obscures the right heart border which on the CXR lateral (right) is located over the heart.

The diagnosis was bacterial pneumonia of the medial segment of the right middle lobe.

School ager with fever and cough

CXR of bacterial pneumonia in right middle lobe — CXR PA (left) shows dense opacity in the lateral aspect of the right mid-lung. CXR lateral (right) shows the opacity to be located in the right middle lobe.

The diagnosis was bacterial pneumonia in the lateral segment of the right middle lobe.

School ager with cough and fever

CXR of bacterial pneumonia in left upper lobe — CXR PA (above left) shows an opacity in the left lung that obscures the left mediastinum and left heart border which on the CXR lateral (above right) is seen to be located in the upper lung. Coronal (below left) and sagittal (below right) CT without contrast of the chest better localizes the opacities in the left upper lung.

The diagnosis was bacterial pneumonia of the left upper lobe.

Preschooler with leukemia who is febrile

The diagnosis was bacterial pneumonia in the posterior segment of the right upper lobe.

Teenager with cough and fever

The diagnosis was bacterial pneumonia in the lingula.

School ager with cough and fever

The diagnosis was bacterial pneumonia in the lingula.

Premature newborn with respiratory distress

CXR of asymmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome — Initial CXR AP (left) shows the lungs to be bilaterally hypoexpanded and to have symmetrical ground glass opacity present throughout them. CXR AP obtained 4 hours after the administration of artificial surfactant (right) shows interval clearing of ground glass opacity from the right lung which is now normally expanded. The left lung remains hypoexpanded and has ground glass opacity throughout it.

The diagnosis was asymmetrical distribution of artificial surfactant into primarily the right lung in a patient with respiratory distress syndrome.

Premature newborn with respiratory distress

CXR of symmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome — CXR AP obtained just after birth (above left) shows the lungs bilaterally to be relatively clear and hypoexpanded. CXR obtained 4 hours later after intubation (above right) shows interval development of bilateral symmetrical ground glass opacity in the lungs which remain hypoexpanded. CXR obtained 4 hours after the administration of artificial surfactant (below) shows the lungs now to be normally expanded and to be clear of the previously seen ground glass opacities.

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

Term newborn with respiratory distress

CXR of respiratory distress syndrome in a term infant due to congenital absence of surfactant — CXR AP shows low lung volumes and symmetrical ground glass opacity throughout both lungs.

The diagnosis was respiratory distress syndrome in a term infant due to congenital inability to produce surfactant.

Premature newborn four hours after administration of artificial surfactant

The diagnosis was respiratory distress syndrome showing the appearance of the chest after the asymmetrical administration of artificial surfactant into only the right lung.

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.

Premature newborn with respiratory distress

CXR of pediatric pulmonary interstitial emphysema — CXR AP shows hazy ground glass opacity throughout the right lung. The left lung is hyperexpanded and has multiple circular bubbly and branching interstitial lucencies that radiate from the left hilum.

The diagnosis was pulmonary interstitial emphysema in the left lung.

Premature newborn with respiratory distress

CXR of pulmonary interstitial emphysema — CXR AP shows hazy ground glass opacity throughout the left lung. The right lung is hyperexpanded and has multiple circular bubbly and branching interstitial lucencies that radiate from the right hilum.

The diagnosis was pulmonary interstitial emphysema in the right lung.

Newborn with respiratory distress

CXR of pediatric Group B streptococcus pneumonia — CXR AP shows normal lung expansion with fine interstitial infiltrates bilaterally.

The diagnosis was Group B streptococcus pneumonia.

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. CXR AP on the second day of life (right) shows interval resolution of the interstitial infiltrates.

The diagnosis was transient tachypnea of the newborn.

School ager with systemic lupus erythematosis with new left pleuritic chest pain

CXR of lupus pneumonitis — CXR AP (left) shows a fine interstitial infiltrate in the left lower lung that on the lateral CXR (right) is seen to be projecting over the spine.

The diagnosis was left lower lobe acute pneumonitis due to systemic lupus erythematosus.

Newborn with respiratory distress

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.

Newborn post intubation

CXR of left mainstem bronchus intubation — CXR AP shows the tip of the endotracheal tube is in the left mainstem bronchus. There is complete opacification of the right hemithorax.

The diagnosis was endotracheal tube malfunction with the tip of the endotracheal tube in the left mainstem bronchus resulting in complete atelectasis of the right lung.

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.