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Age: 1 day (term)

Sex: Male

Indication: Line placement

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Case #4


Findings

  • Left subclavian approach central venous catheter with tip projecting over the superior vena cava
  • Endotracheal tube with tip projecting at the level of T3
  • Enteric tube tip overlies the gastric body
  • Umbilical arterial catheter loops back on itself at the level of T9
  • Scattered patchy pulmonary opacities, most confluent in the left lung base
  • Small left pleural effusion


Diagnosis

  • Neonatal pneumonia

Sample Report

Left subclavian approach central venous catheter with tip projecting over the superior vena cava. No pneumothorax.

Endotracheal tube with tip projecting at the level of T3.

Enteric tube tip overlies the gastric body.

Umbilical arterial catheter loops back on itself at the level of T9. Consider repositioning to reduce the redundant distal coil.

Scattered patchy pulmonary opacities, most confluent in the left lung base, which in combination with a small left pleural effusion raise concern for pneumonia.


Discussion

  • When evaluating chest radiographs in newborns with respiratory distress, try following the decision tree in the annotated image below
  • Neonatal pneumonia can have many different appearances ranging from RDS-like diffuse groundglass opacification to more focal consolidative opacities (similar to meconium aspiration)
  • The presence of asymmetric opacities and an effusion is especially concerning for pneumonia in this case, and this child was diagnosed with group B streptococcal pneumonia


Images

Algorithmic approach to chest radiographs in neonates with respiratory distress. The umbilical arterial catheter, which is difficult to see on this image, ascends to the level of T9 where it then appears to loop back on itself (red arrows).

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