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Neonatal Chest

Lung volumes: High, Normal, Low; normal diaphragm at 10th rib Opacities: Streaky, Perihilar, Granular High volumes with streaky perihilar opacities: Meconium Aspiration Sy, Transient Tachypnea of Newborn, Pneumonia Low volumes with granular opacities: Surfactant deficiency - RDS, Strep B pneumonia Meconium Aspiration Syndrome - MAS: Term or Post-term, Hyperinflation, Asymmetric, perihilar patchy lung densities of ropy appearance, atelectasis, pneumothorax 40% Transient Tachypnea of Newborn - TTN: Wet lung disease, delayed clearance of lung fluid, CS, DM, respiratory distress within 6h, peaks at 24h, resolve by 2-3d; airspace opacification, coarse interstitial markings, cardiomegaly with prominent and indistinct pulmonary vasculature, fluid in fissures, pleural effusion, lung volumes high or normal Neonatal Pneumonia: patchy, asymmetric perihilar densities and hyperinflation, pleural effusion, may look like MAS Surfactant deficient disease SDD: Hyaline membrane disease; RDS; Premature infants, low lung volumes, bilateral, granular opacities, prominent air bronchograms, progress to chronic lung disease Strep B Pneumonia: Most common pneumonia in neonates; Premature; PROM, bilateral granular opacities and low lung volumes similar to SDD, pleural fluid helps to differentiate these 2 as it is uncommon in SDD ECMO: Extracorporeal Membrane Oxygenation for resp. failure due to meconium aspiration, persistent pulmonary hypertension, CHD (Congenital Heart Disease), CDH (Congenital Diaphragmatic Hernia); R-CCA catheter over the aortic arch and IJV over the Right atrium; Pulmonary Interstitial Emphysema - PIE: unique to neonates within 1st week of life, complication of ventilation, rupture of alveoli with air in adjacent interalveolar interstitium - bubble like or linear lucencies, warning sign for pmx; Diffuse pulmonary consolidation in neonates: - Edema (Patent ductus arteriosus PDA) - Hemorrhage (after surfactant therapy) - Worsening surfactant deficiency - Pneumonia Bronchopulmonary dysplasia: Chronic lung disease of prematurity, may look like PIE but not before 2 weeks of life, premies under 32 wks, 50% of neonates born under 1000g, likely caused by mechanical ventilation and O2 toxicity; persistent hazy densities, coarse lung markings, bubblelike lucencies, asymmetric aeration Lucent focal lung lesions in neonates: - Congenital Lobar Emphysema - C-CAM (Congenital Cystic Adenomatoid Malformation) - Persistent PIE - CDH Solid focal lung lesions in neonates: - Sequestration (may infect) - Bronchogenic cyst (may infect) - C-CAM (may infect) - mixed Chronic lung complications of pneumonia: - Bronchiectasis - Swyer-James sy Acute chest syndrome in Sickle Cell Anemia: fever, CP, hypoxia; segmental to lobar pulmonary opacities likely related to rib infarctions, cardiomegaly, between 2 and 6 years, leading cause of death Cystic Fibrosis: Hyperinflation, increased peribronchial markings, mucus plugging, bronchiectasis; focal pneumonia, pmx, pulmonary hemorrhage Pores of Cohns and channels of Lambert, round pneumonia