Emergency Neonatal Chest Imaging: "Challenges and Peculiarities"

The neonatal chest and lung abnormalities can be divided into congenital and acquired or iatrogenic disorders, mostly causing respiratory distress. Congenital lesions include various types of abnormalities such as congenital diaphragmatic hernia, congenital cystic adenoid malformation (CCAM), bronchopulmonary sequestration, lobar emphysema and others. Such conditions are frequently associated with other additional organ malformations. The primary acquired neonatal pulmonary diseases are hyaline membrane disease of premature neonate, meconium aspiration syndrome, transient tachypnea of newborn and neonatal pneumonia. Both congenital and acquired pulmonary disorders in the neonatal period mostly need interventional therapy with the use of mechanical ventilation, oxygen therapy or high frequency ventilation. All these procedures may be complicated by pulmonary air leakage with various intra- and extrapulmonary changes, initially, mostly as interstitial emphysema followed by pneumothorax, pneumomediastinum, pneumopericardium and pneumoretroperitoneum. Such events are always complicated with recurrent atelectasis, acidosis and hypoxemia resulting mostly in chronic lung disease (bronchopulmonary dysplasia). Together with the pulmonary infection, sepsis and other extrapulmonary problems such as intraventricular hemorrhage and necrotizing enterocolitis they result in a high mortality and morbidity rate in this group of infants. The introduction of surfactant therapy in respiratory distress syndrome contributed largely to the reduction of complications in neonatal pulmonary diseases. The imaging of congenital intrathoracic malformations is now frequently recognized by antenatal sonography or MRI if available. The conventional chest X-ray after birth is the first step in the diagnosis of all congenital and acquired neonatal lung disorders for the detection of intrathoracic complications. The prevention of iatrogenic incidents is especially a challenge to the radiologist in this field. The aim of this workshop will be a systematic interpretation of the typical and atypical neonatal chest films including congenital and acquired diseases. Special attention should be paid to the various pulmonary and extrapulmonary complications demonstrated by different pathological signs. Additionally, the radiological signs of patent ductus Botalli on the chest film and the different types and development of chronic lung disease (bronchopulmonary dysplasia) will be shown.