Presentation
Respiratory compromise requiring supplemental oxygen. APGARs normal.
Patient Data
Bilateral interstitial and airspace opacities. The horizontal fissure is prominent, but there is no significant effusion.
Case Discussion
This is a neonate - there is an umbilical cord clamp projected over the middle of the pelvis.
You may be tempted to say that you think the child is preterm because of lack of humeral head ossification, but this is the exception that proves the rule - the child was term.
Without an appropriate history, the differential for the film would be wide (e.g. TTN, neonatal pneumonia), or even an atypical RDS or meconium aspiration.
So, with a history of prolonged labor followed by an emergency cesarian section and without features suggestive of sepsis, the differential narrows. The most likely, with these imaging findings, would be TTN and since there was rapid improvement with diuretic therapy and no subsequent chest radiograph was required, this is a reasonable presumptive diagnosis.
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