Neonatal spontaneous pneumothorax

Case contributed by Roy Waknin

Presentation

A baby boy born at 35 weeks gestation via c-section after a difficult extraction presented with acute respiratory distress which required positive pressure ventilation.

Patient Data

Age: 0 days
Gender: Male
X-ray

Radiographic imaging of the chest at birth

Streaky lucency along the right heart border at the medial right lung base, band-like lucency along the left heart border, and lucencies at the peripheral lung bases are concerning for bilateral, left greater than right, pneumothoraces on this supine examination (marked by arrows on key image).

The cardiothymic silhouette is mildly prominent with mild pulmonary vascular congestion and mild-to-moderate interstitial edema, most likely due to transient tachypnea of the newborn (TTN).

No acute osseous findings. The upper abdomen appears normal.

X-ray

Radiographic imaging of the chest at 1 day old

No definite evidence of a pneumothorax on this exam. Previously seen lucencies around the cardiac border and at the lung bases have resolved.

The cardiothymic silhouette is at upper limits with mild-to-moderate pulmonary interstitial edema and small bilateral pleural effusions, consistent with mild TTN.

Case Discussion

This baby boy born at 35 weeks gestation via c-section after a difficult extraction presenting with floppy tone and poor respiratory efforts. After positive pressure ventilation, he started crying, and color and tone improved. Nasal flaring, grunting, and subcostal retractions were noted so he was placed on continuous positive airway pressure (CPAP) for 5 minutes.

Radiographic imaging showed lucencies around the heart border, a characteristic sign for pneumothorax on supine imaging. Given no history of RDS or meconium stainingthe clinical history and presentation, these findings support a spontaneous pneumothorax as the diagnosis.

This baby did well with supportive measures and did not require chest tubes for treatment as is the expected course of most cases of neonatal pneumothoraces, 

 

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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Case information

rID: 64584
Published: 30th Nov 2018
Last edited: 1st Dec 2018
Inclusion in quiz mode: Included
Institution: Olive View - UCLA Medical Center

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