Respiratory Distress Syndrome

  • Etiology: pre-term infants have not begun producing surfactant, lack of surfactant results in diffuse microatelectasis
  • CXR: low lung volumes and symmetrical (apex to base as well as left to right) ground glass opacity in both lungs (until artificial surfactant is given), bell-shaped chest, most common change seen on serial CXR is atelectasis from decreased ventilator settings in attempt to wean patient off of ventilator
  • Complications:
    — Lung parenchymal disease due to interstitial fibrosis – can choose 2 paths after 30 days: Chronic lung disease or Bronchopulmonary dysplasia
    — Barotrauma – pulmonary interstitial emphysema, pneumopericardium, pneumomediastinum, pneumothorax, pneumoperitoneum
  • Clinical: called respiratory distress syndrome in < 30 days, bronchopulmonary dysplasia or chronic lung disease in > 30 days, can also rarely been seen in term infants who congenitally lack ability to produce surfactant

Cases of Respiratory Distress Syndrome

CXR of respiratory distress syndrome
Initial CXR shows low lung volumes and symmetrical (apex to base as well as left to right) ground glass opacity in both lungs.
CXR of respiratory distress syndrome
CXR AP shows bilaterally poorly expanded lungs with diffuse ground-glass opacities throughout the lungs.
CXR of respiratory distress syndrome / surfactant deficiency disorder
CXR AP shows the lungs to be hypoexpanded with symmetrical ground glass opacity present throughout the lungs from their apex to their base.
symmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome
CXR AP obtained just after birth (left) shows the lungs to be hypoexpanded with symmetrical ground glass opacity present throughout the lungs from their apex to their base. CXR AP taken after the administration of artificial surfactant (right) shows the lungs to now be normally expanded with symmetrical clearing of the previously seen ground glass opacity present throughout the lungs.
CXR of asymmetrical distribution of artificial surfactant in a patient with respiratory distress syndrome
CXR AP obtained just after birth (left) shows the lungs to be hypoexpanded with symmetrical ground glass opacity present throughout the lungs from their apex to their base. CXR AP taken after the administration of artificial surfactant (right) shows the right lung to now be normally expanded with clearing of the previously seen ground glass opacity while the left lung remains hypoexpanded with asymmetrical ground glass opacity present throughout it.
CXR of atelectasis in a patient with respiratory distress syndrome
CXR AP (above) shows symmetrical ground glass opacity in the lungs. CXR AP obtained after decreasing ventilator settings (below) shows interval decreased aeration of the right upper lobe.
CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung along with air in the superior mediastinum.
CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung.
CXR of pulmonary interstitial emphysema
CXR AP shows a branching bubbly appearance to the right lung and a large amount of air in the right pleural space.
CXR of pneumopericardium
CXR AP (above) shows a large amount of air around the heart. CXR AP obtained after pericardiocentesis (below) shows a decreased amount of air around the heart and the diaphragm can be continuously traced across the image.
CXR of pneumomediastinum
CXR AP+lateral shows air around the thymus superiorly and air around the heart inferiorly. The diaphragm can be traced continuously across both images. There is also a small amount of air in the apex of the right pleural space.
CXR of a skin fold simulating a pneumothorax in a patient with respiratory distress syndrome
CXR AP shows diffuse symmetrical ground glass opacity throughout the lungs and a straight line running at an angle across the lower lateral left chest.
CXR of a pneumothorax and a skin fold simulating a pneumothorax in a patient with respiratory distress syndrome
CXR AP shows a small amount of increased lucency laterally in the right lung base and increased lucency in the left lung apex and base. There is also a straight line running at an angle across the lower lateral left chest.
CXR of small bilateral pneumothoraces in patient with respiratory distress syndrome
CXR AP shows diffuse symmetrical ground glass opacity throughout the lungs along with increased lucency in the right lung base laterally and increased lucency distinctly outlining the left cardiomediastinal silhouette.
CXR of basilar pneumothorax in a patient with respiratory distress syndrome
CXR AP shows a large amount of lucency in the left lung base and over the left hemidiaphragm with a chest tube in the center of it.
CXR of pneumothorax in a patient with respiratory distress syndrome
CXR AP shows symmetrical ground glass appearance to the right lung and increased lucency throughout the left hemithorax with a suggestion of a left pleural edge laterally while the cross-table lateral CXR shows a large amount of lucency anterior to the heart.
CXR of tension pneumothorax in patient with respiratory distress syndrome
CXR AP shows a large amount of lucency in the right pleural space and there is mediastinal shift to the left.
CXR of bilateral tension pneumothoraces in a patient with respiratory distress syndrome
CXR AP shows a large amount of lucency in the lung bases bilaterally while the cardiac silhouette is very narrow and small in size. The mediastinum remains in the midline.
CXR of bilateral tension pneumothoraces and pneumomediastinum
CXR AP shows a large amount of lucency in the pleural spaces laterally and inferiorly to the right lung and superiorly and inferiorly to the left lung. There is air outlining the thymus and in the neck. The mediastinum remains in the midline.
AXR of pneumoperitoneum in a patient with respiratory distress syndrome
AXR cross-table lateral shows a distended abdomen with a huge amount of air between the anterior abdominal wall and the abdominal organs.
AXR of pneumoperitoneum in a patient with respiratory distress syndrome
CXR AP shows a bubbly branching appearance to the right lower lobe and overall increased lucency throughout the entire abdomen.
CXR of chest tube malfunction with chest tube in the subcutaneous tissues of the chest wall
CXR AP shows diffuse ground glass opacity throughout the lungs and a large amount of air in the right pleural space causing mediastinal shift to the left while the right-sided chest tube courses through the subcutaneous tissues of the right chest wall and never enters the right pleural space.
CXR of endotracheal tube in the right mainstem bronchus in a patient with respiratory distress syndrome
CXR AP shows an endotracheal tube with its tip projecting deep within the right mainstem bronchus. There is partial atelectasis of the right upper lobe with no mediastinal shift. There are diffuse ground glass opacities present throughout the lungs.
CXR of endotracheal tube in the esophagus in a patient with respiratory distress syndrome
CXR AP shows an endotracheal tube with its tip projecting beneath the carina and not over either mainstem bronchus and a distended stomach. There are diffuse ground glass opacities present throughout the lungs. CXR lateral shows the endotracheal tube to be posterior to the trachea and in the esophagus.
CXR of umbilical arterial catheter malposition
CXR AP shows the tip of the umbilical arterial catheter to be at T3 near the aortic arch. The tip of the umbilical venous catheter is in the right portal vein. The lungs show diffuse ground-glass opacity.
CXR of umbilical arterial catheter in left subclavian artery
CXR AP shows the tip of the umbilical arterial catheter to be in the left subclavian artery. The tip of the umbilical venous catheter is deep within the right atrium. The lungs show minimal ground-glass opacity.
AXR of umbilical arterial catheter malposition
Supine and cross-table lateral AXR shows the tip of one umbilical arterial catheter to be at T6 and the tip of the other umbilical arterial catheter to be at L1. Note on these images how after insertion at the umbilicus the umbilical arterial catheters first head caudad in the umbilical artery and internal iliac artery before heading cephalad in the common iliac artery and aorta. There is faint ground-glass opacity in the lungs.
CXR of umbilical venous catheter in a pulmonary vein
CXR AP shows the umbilical venous catheter coursing into the right atrium, through a patent foramen ovale, into the left atrium and then into a left pulmonary vein. The umbilical arterial catheter tip is at T4. There is faint ground glass opacity in the lungs.
CXR of umbilical venous catheter in right atrium and superior vena cava
CXR AP shows the tip of one umbilical venous catheter to be in the superior vena cava with the tip of the other umbilical venous catheter curled within the right atrium. The tip of the endotracheal tube is in the right mainstem bronchus. The lungs have ground-glass opacity.
AXR of portal venous gas from an umbilical venous catheter in the right portal vein
CXR AP shows the tip of the umbilical venous catheter to be in the right portal vein. There is air in the portal venous system. The umbilical arterial catheter projects at T9. There is mild ground-glass opacity in the lungs.
AXR of umbilical venous catheter in right portal vein
CXR AP shows the tip of the umbilical venous catheter within the right portal vein. The tip of the umbilical arterial catheter is at T5. There is ground-glass opacity in the lungs.
AXR of umbilical venous catheter in the left portal vein
CXR AP shows the tip of the umbilical venous catheter projecting over the left portal vein. The tip of the umbilical arterial catheter projects at T6. There is hazy ground glass opacity in the lungs.
CXR of peripherally inserted central catheter / PICC changing in position as arms move up and down
CXR AP with the left arm down (left) shows the tip of the left upper extremity PICC to project deep within the right atrium. CXR AP with the left arm up (right) obtained later the same day shows the tip of the PICC to have moved back into the superior vena cava. There is ground glass opacity throughout the lungs.