Presentation
Premature infant, born at 27 weeks gestation. Distended abdomen. To exclude NEC.
Patient Data
The portable supine X-ray reveals background surfactant deficiency disorder with well-inspired lung fields, a central trachea and a normal cardiomediastinal contour. There is a nasogastric tube (NGT) in situ, overlying temperature lead, and a right upper limb peripherally inserted central catheter (PICC).
There is tubular gaseous distention suggestive of developing necrotizing enterocolitis (NEC) with no bowel obstruction. There are suspicious upper abdominal gaseous lucencies, confirmed to be artifactual and related to the overlying thermal wrap, predominantly overlying the thorax and upper abdomen as demonstrated in the windowed image.
Case Discussion
An example of stable surfactant deficiency disorder in a premature infant that subsequently develops NEC.
The overlying thermal wrap creates an unusual artifact mimicking upper abdominal free intraperitoneal air and intrahepatic portal venous gas in a setting of clinically suspected NEC. Windowing the image confirms the gaseous lucencies to be artifactual, overlying the upper thorax and bilateral shoulders and extraskeletal.
Teaching point: always be aware of overlying thermal wraps/blankets creating artifacts mimicking pathology in premature infants. If in doubt, consider a lateral shoot-through or the removal of the wrap when imaging these patients. In these instances, the imaging must be rapid to prevent excessive heat loss.
See companion cases: rID192506 and rID 192516
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