DDX of complications of respiratory distress syndrome

Approach to the DDX of complications of respiratory distress syndrome:

  • Ground glass opacity due to microatelectasis is symmetrical in appearance in respiratory distress syndrome but usually becomes asymmetrical in appearance after use of artificial surfactant
  • Atelectasis from decreased ventilation support is the most common change seen on serial premature newborn CXRs
  • Barotrauma
    • Pulmonary interstitial emphysema has a bubbly branching pattern
    • Pneumopericardium is air beneath the great vessels and around the heart
    • Pneumomediastinum is air in the mediastinum above the great vessels
    • Pneumothorax is air in the pleural space
      Note: tension pneumothorax causing mediastinal shift is potentially life threatening and must be treated immediately
      Note: skin fold can mimic a pneumothorax
    • Pneumoperitoneum is air in the abdomen
  • Lung parenchymal disease after 30 days due to interstitial fibrosis
    • Chronic lung disease has normal lung volumes
    • Bronchopulmonary dysplasia has increased lung volumes and focal emphysematous blebs