Neonatal Chest X Ray Interpretation
Types of C hest Films PA Routine CXR taken at a greater distance than AP to give better clarity and less magnification (6 feet = true to size). AP Portable films taken at a closer distance for critical or bedridden patients. LATERAL To better assess the position and degree of abnormality seen in PA/AP view. LATERAL DECUBITUS Taken with the patient lying on the affected side to assess fluid within the chest. OBLIQUE Allows for visualization of the middle and lower lobes.
Densities of X rays AIR Density of the lungs FAT Not seen on CXR. Found around some muscles WATER Density of the heart, muscles, blood. METAL / BONE Density of the ribs (calcium)
Reviewing Film s Systematically Position Observe Soft Tissues Mediastinal Stuctures Hilar Area Diaphragms Bony Structures Determining Landmarks
Positio on Look for equal distance from spine to lateral ribcage. Clavicles normally rest at 90 degree angle. Is the patient ROTATED!
Observe Sof ft Tissues X ray penetration underexposed overexposed Edema Subcutaneous air
Mediastinal Structures Observe contour Shift from midline Widening Thymus present
Hilar A rea Vascularity Increased markings andbutterfly shape indicate pulmonary congestion.
Diaphra gms Assess lung inflation Clarity of costophrenic angles Position of hemidiaphragmsms
Bony Stru ctures Observe ribs for fractures Clavicles l for fractures Vertebrae for scoliosis
Determining l andmarks Count ribs top to bottom th en count backwards bottom to top. NEVER assume 12 sets of ribs!! ET placement usually T1 T2. NG tube UAC High placement T9 T10 Low placement L3 L4
Respiratory Distre ess Syndrome (RDS) Definition: Hyaline Mem mbrane Disease Surfactant Deficiency of the lung causing decreased lung compliance and atelectasis Pathophysiology: Commonly occurs in premature infants.
Respiratory Distre ess Syndrome (RDS) Hyaline Mem mbrane Disease Pathophysiolo ogy: Commonly occu urs in premature infants. Maternal diabete es Stress that caus ses acidosis
Respiratory Distre ess Syndrome (RDS) Hyaline Mem mbrane Disease Symptoms Tachypnea retractions grunting g nasal flaring cyanosis
Respiratory Distre ess Syndrome (RDS) Surfactanct df deficiency prematurity deactivation asphyxia insult Low lung volumes ou Air bronchograms Ground glass appearance
Treatment Respiratory Distre ess Syndrome (RDS) Oxygen therapy Nasal CPAP Hyaline Mem mbrane Disease Mechanical ventilation High High frequency frequency ventilatio on Surfactant replacement therapy Exosurf 5cc/kg Survanta 4cc/kg
RDS
Transient Tachpnea of the Newborn (TTN) RDS II Definition: Retention of lung water causing respiratory distress. Pathophysiology: Commonly occurs in term or near term infants. Cesarean section Precipitous birth Sepsis
Transient Tachpneaa of the Newborn (TTN) RDS II Poor pulmonary cleara ance of fluid Increased V/Q mismatch Poor surfactant distribution Increased surface tens sion Atelectasis
Transient Tachpnea of the Newborn (TTN) R DS II Diagnosis: Follows same symptoms of RDS Tachypnea, nasal flaring, retractions, and grunting. X ray Fluffy or streaky infiltrates. Fluid in the fissure. Symptoms gradually cle ear within 24 48 hours.
Transient Tachypn nea of the Newborn Perihilar congestion Fluffy infiltrates Fluid in the transverse fissure May have underlying RDS
Transient Tachpneaa of the Newborn (TTN) RDS II Treatment: Treat hypoxia via head hood O2 (warm / humidified) CPAP therapy to treat refractory hypoxemia. R/O other possibilities of Respiratory Distress (pnuemonia)
Transient Tachy ypnea of the Newborn Day 1 Day 2
RDS / TTN
Group B Streptoc coccus Pneumonia Septecemia, respiratory distress, shock, respiratory failure. Within 24 hours if not treated Can closely mimic RDS course
Diagraphragm matic Hernia Absence of hemidiaphragm to fully formed Bowel in chest Hypoplastic lung
Bronchopulmo onary Dysplasia Patchy, cystic changes Scarring Barrel chest (Usually to some degree)
BP PD
Meconium Aspirat ion Syndrome (MAS) Non homogeneous, patchy density (atelectasis / hyperaeration) Often perihilar congestive streaking
Pulmonary Interstitial Emphysema Small bubbled trapped gas surrounded by collapsed alveoli Grades range from grade 1 to grade 3 P IE