Bronchopulmonary dysplasia

Endotracheal tube with theits tip just above the carina and hence, placed a little too deep.

Umbilic arteryUmbilical arterial line malpositioned with folded line in a large aortic branch, either right renal artery/, SMA /or coeliac trunk.

Moderate ground glass opacification with bilateral central dominance. The cardiac silhouette remains visible as does the diaphragm.

CONCLUSION: mild to moderate IRDS with centrally located ground glass airspace and interstitial opacities with mild air-bronchograms bronchograms. Some semi-optimalSuboptimally placed lines and tubes.

The x-ray taken the next day shows removal of the umbilic arteryumbilical arterial line and the endotracheal tube and a newly inserted central venous line via the left brachial vein, theits tip remaining in the subclavian vein, hence no central positioningnot centrally positioned.

Discrete progression of ground glass opacification with loss of visibility of the cardiac silhouette. Dilated small bowel loops in the upper abdomen, inserted NGT inserted in correct position.

X-RAY FINDINGS: Bilateral ill-defined reticulo-nodularreticulonodular markings predominantly, more prominent on the right, with obscuration of the right hemidiaphragm and heart border, positive air-bronchograms and hyperinflation of the left lower zone. No apparent atelectasis. The widened upper mediastinum on the right is most likely due to non-centric projection (see trachea and clavicles). Dilated small and large bowel loops.

CONCLUSION: Given the history of a preterm neonate with IRDS and consecutive prolonged oxygenation therapy and normal infection parameters (normal CRP and leucocyte count), the most likely diagnosis is bronchopulmonary dysplasia (BPD).

The child went on to have a prolonged CPAP therapy for 42 days and intermittent high flow-flow oxygenation for another 5 days. Two months later, a control x-ray was taken because the child still suffered from abnormal respiratory function and shortness of breath which required permanent respiratory support.

The case illustrates a feared consequence of IRDS and consecutive high-pressure oxygenation in preterm neonates:  bronchopulmonary dysplasia, (BPD).

Clinically, this young fellow recovered quite well and was discharged from hospital some weeks later. The oxygen therapy could be reduced step by step from permanent to intermittent to zero and currently his medication is an inhaled corticosteroid. His lunglungs, however, will most most likely suffer from some irreversible parenchymal damage.