Presentation
A baby girl born at 39 weeks gestation via urgent c-section with acute respiratory distress, desaturation and thin meconium at delivery which required suctioning.
Patient Data
Diffuse lucency (marked by arrows # key image) at the anteromedial aspect adjoining the cardiothymic silhouette bilaterally, right much greater than left, concerning for pneumothoraces on this supine evaluation.
Mild diffuse pulmonary vascular congestion/interstitial edema, trace bilateral pleural effusions, and small right fissural effusion with slightly prominent cardiothymic silhouette and hyperinflation are most compatible with transient tachypnea of the newborn (TTN).
Hazy opacification in the right lower zone and peripheral left lower zone are concerning for airspace disease, atelectasis/aspiration in this term baby with history of thin meconium staining.
No acute osseous findings. The upper abdomen appears normal.
Much improving, possible trace right and left pneumothorax manifest as lucency around the cardiac border and at the lung bases.
The cardiothymic silhouette is now normal sized considering technique.
Improving pulmonary interstitial edema/atelectasis in the right lower zone, now minimal.
Case Discussion
A baby girl born at 39 weeks gestation via urgent c-section with acute respiratory distress, desaturation, and thin meconium at delivery which required suctioning.
Radiographic imaging showed a halo of lucency around the cardiac silhouette, a characteristic sign for anteromedial pneumothorax on supine imaging. Pulmonary vascular congestion and small pleural effusions suggest transient tachypnea of the newborn (TTN), and basilar airspace disease suggests meconium aspiration. Given the clinical history and presentation meconium aspiration is the etiology for the pneumothoraces in this baby.
This baby did well with supportive measures and did not require chest tubes for treatment as is the expected course of most cases of pneumothorax,
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of medicine at UCLA
Olive View-UCLA Medical Center
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