Neonatal respiratory distress syndrome, pneumothorax, and PICC line malposition

Case contributed by Bálint Botz
Diagnosis certain


Premature (33rd week) newborn, transferred after RDS and left-sided pneumothorax was confirmed on CXR, the latter treated with drainage in the referring hospital. Worsening SpO2. Transillumination suggestive of recurrent pneumothorax.

Patient Data

Age: neonate
Gender: Male
  • Generally reduced lung volume with bell-shaped chest, diffuse bilateral granulation in all lung zones - findings are in line with moderate neonatal respiratory distress syndrome. 
  • Increased transparency of the left lower hemithorax with subtle cardiomediastinal shift to the right, however maintained position of the diaphragm - virtually pathognomonic for pneumothorax.
  • Status post PICC line insertion on the right. The catheter arches back peripherally, indicative of malposition. 
  • NG tube in situ, status post intubation with good tube position. 

Case Discussion

Unilateral hypertranslucent hemithorax as a sign of pneumothorax on a neonatal AP CXR is often hard to appreciate, especially if multiple co-existing pathogies overlap. 

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