Newborn chest reid

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  • Ask one question- what is the gestational age What is this pattern What is the most helpful associated finding for this diagnosis.
  • Ground glass
  • What is the pattern: Course reticular
  • Pattern- fine reticular
  • Pattern: multiple radiolucencies
  • Pattern: mass
  • Pattern: Increased blood flow
  • Which is pulm agenesis and which is atelectasis
  • Newborn chest reid

    1. 1. Newborn Chest Janet R Reid MD, FRCPCChildren’s Hospital of Philadelphia Fellow Radiology Lecture Series 2012
    2. 2. Part I Common PatternsFellow Radiology Lecture Series 2012
    3. 3. Ground Glass Clinical Clue: Gestational age: RDS always in premature Xray Clue: Pleural effusion rare in RDSRDS vs Group B Strep infectionFellow Radiology Lecture Series 2012
    4. 4. Fine Reticular Clinical Clue: History of C-Section in TTN Xray Clue: Cardiomegaly more pronounced in Heart DiseaseTransient tachypnea vs edemaFellow Radiology Lecture Series 2012
    5. 5. Coarse Reticular Clinical Clue: Thick meconium at birth; fetal distress Xray Clue: Effusion more common in pneumoniaMeconium aspiration vs pneumonia Fellow Radiology Lecture Series 2012
    6. 6. Mass Clinical Clue: Presence and appearance on prenatal US Xray Clue: Doppler showing systemic vesselSequestration vs bronchogenic cyst Fellow Radiology Lecture Series 2012
    7. 7. Multiple Lucencies Clinical Clue: Growth pattern on prenatal US; RDS Xray Clue: Location of stomach bubbleDiaphragmatic hernia vs cystic adenomatoid malformation (vs pulmonary interstitial emphysema) Fellow Radiology Lecture Series 2012
    8. 8. Increased Blood Flow Clinical Clue: Murmur Xray Clue: Distinctness of vessels Intracardiac Shunt vs Edema Fellow Radiology Lecture Series 2012
    9. 9. Case: Newborn child (3 hours old) with grunting and nasal flaring Fellow Radiology Lecture Series 2012
    10. 10. Ground Glass Clinical Clue: Gestational age: RDS always in premature Xray Clue: Pleural effusion rare in RDSRDS vs Group B Strep infection Fellow Radiology Lecture Series 2012
    11. 11. Cases: 2 premature newborns with respiratory distress/same pattern A B Fellow Radiology Lecture Series 2012
    12. 12. Cases: 2 premature newborns with respiratory distress/same pattern RDS Pneumonia Fellow Radiology Lecture Series 2012
    13. 13. RDS • Alveolar collapse • Interstitial thickening • Epithelial injury • Bronchiolar distensionFellow Radiology Lecture Series 2012
    14. 14. RDS • Symmetric ground glass • Air bronchograms • Low lung volumes • NO PLEURAL EFFUSIONFellow Radiology Lecture Series 2012
    15. 15. Case: Full term newborn admitted to NICU with labored breathing Fellow Radiology Lecture Series 2012
    16. 16. Coarse Reticular: Differential Diagnosis• Meconium Aspiration• Pneumonia No pleural effusion• Partially treated RDS Full Term• Transient Tachypnea Rarely Fellow Radiology Lecture Series 2012
    17. 17. Meconium Aspiration • Full term, fetal distress • Bile acids • Small airway inflammation • Thick exudate • Obstruction Fellow Radiology Lecture Series 2012
    18. 18. Meconium Aspiration • Subsegmental collapse • Compensatory overinflation • Coarse lines • PTX (25%) Fellow Radiology Lecture Series 2012
    19. 19. Neonatal Pneumonia • Airspace filling • E Coli; Streptococcus; Staphylococcus • No clinical markers • Prolonged rupture of membranes Fellow Radiology Lecture Series 2012
    20. 20. Neonatal Pneumonia •Patchy asymmetric densities •Hyperinflation •Pleural effusion Fellow Radiology Lecture Series 2012
    21. 21. Case: Term child born by C Section Fellow Radiology Lecture Series 2012
    22. 22. Fine Reticular: Differential Diagnosis• Transient tachypnea of the newborn (retained fetal lung liquid)• Pulmonary edema Heart usually bigger• Pneumonia No clinical or radiographic improvement Fellow Radiology Lecture Series 2012
    23. 23. Transient Tachypnea •Caesarian section •Lack of squeezing of chest during delivery •Fluid in interstitium and airspaces Fellow Radiology Lecture Series 2012
    24. 24. Transient Tachypnea • Interstitial edema • Possible cardiomegaly • Pleural effusion • Rapid improvement in 24 hours Fellow Radiology Lecture Series 2012
    25. 25. Cases: 2 preterm children with respiratory distress Fellow Radiology Lecture Series 2012
    26. 26. Multiple Lucencies: Differential Diagnosis• Congenital Diaphragmatic Mass effect; stomach up Hernia Mass effect; stomach down• Congenital Cystic Adenomatoid Malformation Prematurity; day 3• Pulmonary ventilation Interstitial Emphysema Fellow Radiology Lecture Series 2012
    27. 27. Cases: 2 preterm children with respiratory distress CDH PIE Fellow Radiology Lecture Series 2012
    28. 28. CDH •Foramen of Bochdalek •Failure of mesenchymal induction •Mass effectFellow Radiology Lecture Series 2012
    29. 29. CDH • More commonly left-sided • Stomach, intestine, liver, spleen •>35% associated heart disease • Pulmonary hypoplasia • Contralateral lung: prognosisFellow Radiology Lecture Series 2012
    30. 30. PIE • RDS, pressure ventilation • “Air block” • Interstitium and lymphaticsFellow Radiology Lecture Series 2012
    31. 31. PIE • Multiple dark distinct rounded lucencies • Ventilator settings “going up” • Can progress to PTX, pneumomediastinum, pneumoperitoneum, pneumopericardium, parenchymaFellow Radiology Lecture Series 2012
    32. 32. Case: Asymptomatic newborn• Chest mass Fellow Radiology Lecture Series 2012
    33. 33. Mass: Differential Diagnosis• Congenital Diaphragmatic Where is the Hernia stomach?• Diaphragm Possible Eventration• Cystic Adenomatoid Not cystic Malformation• Bronchogenic Cyst Location• Sequestration Possible Fellow Radiology Lecture Series 2012
    34. 34. Sequestration • Present prenatally • Diagnosis: Doppler or MRI • Systemic arterial supply • Systemic (ELS) or pulmonary (ILS) venous drainageFellow Radiology Lecture Series 2012
    35. 35. CCAM/CPAMFellow Radiology Lecture Series 2012
    36. 36. Bronchogenic CystFellow Radiology Lecture Series 2012
    37. 37. Mass: Differentiating Features• Congenital Diaphragmatic Hernia: • Prenatal diagnosis (fetal MRI) • Respiratory distress • High position of the stomach• Diaphragm Eventration: • Cannot differentiate from CDH with imaging• Cystic Adenomatoid Malformation: • Prenatal diagnosis; US; CT• Bronchogenic Cyst: • Usually mediastinal or right-sided parenchymal Fellow Radiology Lecture Series 2012
    38. 38. Cases: Two full term newborns with tachypnea A B Fellow Radiology Lecture Series 2012
    39. 39. Cases: Two full term newborns with tachypnea • In edema the vessels are indistinct • With shunt vascularity, they are big and distinct • In both there is usually cardiomegaly Edema Shunt Fellow Radiology Lecture Series 2012
    40. 40. Part II Additional PatternsFellow Radiology Lecture Series 2012
    41. 41. Focal Lucency PNEUMOMEDIASTINUM • Uplifted thymus • Can progress to PTX, pneumoperitoneum, pneumopericardium, parenchymaFellow Radiology Lecture Series 2012
    42. 42. Focal Lucency PNEUMOTHORAX PNEUMOTHORAX • Spontaneous or related to ventilation • ALWAYS UNDER TENSIONFellow Radiology Lecture Series 2012
    43. 43. Small Thorax PULMONARY HYPOPLASIA • Dysplastic, obstructed or absent kidneys • Oligohydramnios leads to pulmonary hypoplasiaFellow Radiology Lecture Series 2012
    44. 44. Asymmetric VentilationCHRONIC LUNG DISEASE OF CHRONIC LUNG DISEASE OF PREMATURITY PREMATURITY• Air trapping• Atelectasis• Cysts Fellow Radiology Lecture Series 2012
    45. 45. Opaque HemithoraxA B Fellow Radiology Lecture Series 2012
    46. 46. Opaque Hemithorax PULMONARY AGENESIS PULMONARY AGENESIS ATELECTASIS ATELECTASIS • Pleural rind • +/- Air bronchograms • No lung markings • ET tubePulmonary Agenesis Atelectasis Fellow Radiology Lecture Series 2012
    47. 47. Summary• There are several common patterns of disease on newborn chest radiographs• One can differentiate between diseases based on clinical and radiographic clues• Important to adopt a differential diagnosis to include 2 “top contenders” for each pattern• Use ultrasound and prenatal MRI in pediatric chest disease Fellow Radiology Lecture Series 2012
    48. 48. Summary GROUND GLASS FINE RETICULAR COARSE RETICULAR• Gestational age: RDS • History of C-Section • Thick meconium atalways in premature in TTN birth; fetal distress • Cardiomegaly more • Effusion more• Pleural effusion rare pronounced in Heart common inin RDS Disease pneumonia RDS vs GBS TTN vs Edema Meconium vs Infection Pneumonia Fellow Radiology Lecture Series 2012
    49. 49. Summary MASS MULTIPLE LUCENCIES INCREASED FLOW• Presence and • Growth pattern on • Murmurappearance on prenatal US; RDSprenatal US• Doppler showing • Location of stomach • Distinctness ofsystemic vessel bubble vessels Sequestration vs CDH vs CCAM vs PIE Edema vs L-->Rbronchogenic cyst Shunt Fellow Radiology Lecture Series 2012

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