Respiratory distress syndrome

Case contributed by Dr Jeremy Jones

Presentation

Respiratory distress in a neonate in the hours after a cesarian section.

Patient Data

Age: Neonate
Gender: Male
X-ray

Intubated.  Widespread granular opacities throughout both lungs with air bronchograms centrally confirming that these are airspace opacities.  No significant effusion.

There are no humeral head ossification centres and the chest has a bell-shaped configuration suggesting that the child is preterm.

The child is intubated meaning that lung volumes cannot be used for assessment. 

X-ray

Day 2

Slight clearing of the granular opacities peripherally with central prominence of continued airspace opacification.

Case Discussion

There is a diffuse and generalised process occurring in the lungs of this neonate. The opacification is centered in the airspace although there are interstitial opacities too. There is no significant effusion. 

Given the history of recent cesarean section, one might be led towards TTN as the diagnosis.

However, there are features that suggest this neonate is preterm (lack of humeral head ossification and a bell-shaped thorax).  Since the neonate is ventilated the rule about only seeing RDS in low-volume lungs does not hold.

On day 2, there has been some improvement, but not the marked improvement one would expect if this were TTN being treated with diuretics. The diagnosis here is RDS.

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Case information

rID: 23896
Case created: 17th Jul 2013
Last edited: 18th Jan 2017
Systems: Paediatrics, Chest
Inclusion in quiz mode: Included

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