Differential diagnosis of complications of respiratory distress syndrome

• Asymmetrical distribution of artificial surfactant
• Atelectasis from hypoventilation
• Pulmonary interstitial emphysema
• Pneumopericardium
• Pneumomediastinum
• Pneumothorax
• Pneumoperitoneum
• Chronic lung disease
• Bronchopulmonary dysplasia

Approach to the differential diagnosis 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