1. Newborn Chest
Janet R Reid MD, FRCPC
Children’s Hospital of Philadelphia
Fellow Radiology Lecture Series 2012
2. Part I
Common Patterns
Fellow Radiology Lecture Series 2012
3. Ground Glass
Clinical Clue:
Gestational age: RDS
always in premature
Xray Clue:
Pleural effusion rare in RDS
RDS vs Group B Strep infection
Fellow Radiology Lecture Series 2012
4. Fine Reticular
Clinical Clue:
History of C-Section in
TTN
Xray Clue:
Cardiomegaly more
pronounced in Heart
Disease
Transient tachypnea vs edema
Fellow Radiology Lecture Series 2012
5. Coarse Reticular
Clinical Clue:
Thick meconium at birth;
fetal distress
Xray Clue:
Effusion more common in
pneumonia
Meconium aspiration vs pneumonia
Fellow Radiology Lecture Series 2012
6. Mass
Clinical Clue:
Presence and
appearance on prenatal
US
Xray Clue:
Doppler showing
systemic vessel
Sequestration vs bronchogenic cyst
Fellow Radiology Lecture Series 2012
7. Multiple Lucencies
Clinical Clue:
Growth pattern on
prenatal US; RDS
Xray Clue:
Location of stomach
bubble
Diaphragmatic hernia vs cystic adenomatoid
malformation (vs pulmonary interstitial
emphysema)
Fellow Radiology Lecture Series 2012
8. Increased Blood Flow
Clinical Clue:
Murmur
Xray Clue:
Distinctness of vessels
Intracardiac Shunt vs Edema
Fellow Radiology Lecture Series 2012
9. Case: Newborn child (3 hours old) with grunting
and nasal flaring
Fellow Radiology Lecture Series 2012
10. Ground Glass
Clinical Clue:
Gestational age:
RDS always in premature
Xray Clue:
Pleural effusion rare in RDS
RDS vs Group B Strep infection
Fellow Radiology Lecture Series 2012
11. Cases: 2 premature newborns with respiratory
distress/same pattern
A B
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12. Cases: 2 premature newborns with respiratory
distress/same pattern
RDS Pneumonia
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21. Case: Term child born by C Section
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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. Transient Tachypnea
•Caesarian section
•Lack of squeezing of chest
during delivery
•Fluid in interstitium and
airspaces
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24. Transient Tachypnea
• Interstitial edema
• Possible cardiomegaly
• Pleural effusion
• Rapid improvement in 24 hours
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25. Cases: 2 preterm children with respiratory distress
Fellow Radiology Lecture Series 2012
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. Cases: 2 preterm children with respiratory distress
CDH PIE
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28. CDH
•Foramen of Bochdalek
•Failure of mesenchymal
induction
•Mass effect
Fellow Radiology Lecture Series 2012
33. Mass:
Differential Diagnosis
• Congenital
Diaphragmatic Where is the
Hernia stomach?
• Diaphragm
Possible
Eventration
• Cystic
Adenomatoid Not cystic
Malformation
• Bronchogenic Cyst Location
• Sequestration Possible
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34. Sequestration
• Present prenatally
• Diagnosis: Doppler or MRI
• Systemic arterial supply
• Systemic (ELS) or
pulmonary (ILS) venous
drainage
Fellow Radiology Lecture Series 2012
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. Cases: Two full term newborns with tachypnea
A B
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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
46. Opaque Hemithorax
PULMONARY AGENESIS
PULMONARY AGENESIS ATELECTASIS
ATELECTASIS
• Pleural rind • +/- Air bronchograms
• No lung markings • ET tube
Pulmonary Agenesis Atelectasis
Fellow Radiology Lecture Series 2012
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. Summary
GROUND GLASS FINE RETICULAR COARSE RETICULAR
• Gestational age: RDS • History of C-Section • Thick meconium at
always in premature
in TTN birth; fetal distress
• Cardiomegaly more • Effusion more
• Pleural effusion rare pronounced in Heart common in
in RDS Disease pneumonia
RDS vs GBS TTN vs Edema Meconium vs
Infection Pneumonia
Fellow Radiology Lecture Series 2012
49. Summary
MASS MULTIPLE LUCENCIES INCREASED FLOW
• Presence and • Growth pattern on • Murmur
appearance on
prenatal US; RDS
prenatal US
• Doppler showing • Location of stomach • Distinctness of
systemic vessel bubble vessels
Sequestration vs CDH vs CCAM vs PIE Edema vs L-->R
bronchogenic cyst Shunt
Fellow Radiology Lecture Series 2012
Editor's Notes
Ask one question- what is the gestational age What is this pattern What is the most helpful associated finding for this diagnosis.
