A frontal chest radiograph shows diffuse, mild, bilateral, airspace density that persisted throughout the course. Note bilateral air bronchograms, left chest tube, normal lung volume, and normal-sized heart.
Differential diagnosis: Diffuse lung density in a term newborn is seen commonly in transient tachypnea of the newborn (TTN) or "wet lung syndrome", and is usually associated with normal lung volume and often small pleural effusions. TTN is a diagnosis of exclusion and one should see the radiographic and clinical pictures clearing quickly, usually within a few days. Pneumonia in the newborn is not common but can be serious. Pneumonia caused by group B streptococci, often associated with prolonged rupture of membranes and foul-smelling amniotic fluid, and viral pneumonia, particularly cytomegaloviral, can appear as diffuse, mild lung density. Meconium aspiration syndrome appears radiographically as bilateral, patchy densities and enlarged lung volume, and is suspected because of meconium found in the amniotic fluid. Respiratory distress syndrome (RDS) usually occurs in premature newborns of low birth weight and is due to inadequate surfactant production by the type II alveolar cells and resultant hypoaeration of the lung.
Persistent pulmonary hypertension (persistent fetal circulation) has many causes, and the entity is associated with shunting of various sorts (such as vein of Galen arteriovenous malformation or liver hemangioma). The lungs may show diffuse mild edema or appear normal, and the heart may be normal or enlarged. Congenital heart disease such as hypoplastic left heart syndrome may present as diffuse mild pulmonary edema with normal heart size.
Leonidas JC, Berdon W. The neonate and young infant. In: F Silverman, J Kuhn, (eds): Caffey's Pediatric X-ray Diagnosis: An Integrated Imaging Approach, 9th ed, St. Louis, Mosby, 1993.
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