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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: can choose 2 paths after 30 days: Chronic lung disease or Bronchopulmonary dysplasia
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
Initial CXR shows low lung volumes and symmetrical (apex to base as well as left to right) ground glass opacity in both lungs.CXR AP shows bilaterally poorly expanded lungs with diffuse ground-glass opacities throughout the lungs.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 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 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 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 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.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 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 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.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.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.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.
