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

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 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.