The Utility of Special Radiological Signs on Routinely Obtained Supine Anteroposterior Chest Radiographs for the Early Recognition of Neonatal Pneumothorax

Abstract

Background: Bedside chest radiographs used for the confirmation of diagnosis of pneumothorax in the neonatal intensive care unit (NICU) are routinely obtained in the supine position. However, pneumothoraces may not appear in the classically described forms on these radiographs, resulting in a delayed diagnosis. Objective: To assess the utility of special radiological signs in the neonatal population for the early recognition of pneumothorax. Methods: A case-control study was conducted at a level III referral center from January 2006 to December 2012. For each neonate with pneumothorax, one infant was selected for the control group. A senior radiologist and neonatologist experienced in reading chest radiographs evaluated each radiograph for the presence of special radiological signs. Results: Of the 1,375 infants admitted to the NICU during the study period, 39 had a pneumothorax. A total of 223 radiographs were scored and 46% of the neonates were found to have occult pneumothoraces before they were clinically diagnosed. Twenty-six percent had a single sign detected on a radiograph, whereas 20% had multiple signs. The time interval between the appearance of these signs and clinical diagnosis ranged between 0.5 and 27 h. Conclusions: The present study shows that the recognition of these signs would assist the physician in identifying occult pneumothorax earlier in its course. Physicians dealing with critically ill infants should ensure that they can recognize these radiological signs.

Personal smartphones for neonatal diagnostic imaging: A prospective crossover study

“…To our knowledge, no tested method has achieved 100% accuracy. Accuracy in our study is likely to be <100% because diagnosing neonatal pneumothorax can be difficult regardless of the media used to review the image.…”

Significance of small anteromedial or subpulmonic pneumothoraces on admission chest radiographs in late preterm/term neonates

“…Per Jiang et al, (2015), close monitoring of respiratory status is indicated for neonates who received ventilation support at birth. Intensive care is required for neonates who received delivery room intubation with or without CPR, especially during the first week of life [5].…”

“…Interestingly, aggressive resuscitation through positive pressure ventilation (PPV) and continuous positive airway pressure (CPAP) is a known risk factor for pulmonary air leak and can result in dissection of air into the pleural space or mediastinum, known respectively as pneumothorax (PTX) or pneumomediastinum (PM), as confirmed through chest radiographs (CXR) [5,6]. Most cases of air leak occur in neonates with underlying lung disease, especially if mechanical ventilation is required [7].…”

Respiratory Care for the Ventilated Neonate

“…The clinical presentation ranges from asymptomatic to severe progressive respiratory distress [ 102 ] and, in case of tension pneumothorax, hemodynamic compromise [ 109 ]. Physical examination may reveal tracheal deviation, asymmetrical chest rise, diminished breath sounds over the affected side, and muffled or shifted heart sounds [ 109 ]. Diagnosis is usually made by radiography [ 109 ].…”

“…Physical examination may reveal tracheal deviation, asymmetrical chest rise, diminished breath sounds over the affected side, and muffled or shifted heart sounds [ 109 ]. Diagnosis is usually made by radiography [ 109 ]. However, in neonates, the classic appearance may be more difficult to recognize.…”