Tuesday, May 29, 2012

Neonatal Lung Disease Differential Diagnosis

The (almost) Daily Diff today is Neonatal lung disease, which contains several entities unique to that age group, as well as many of the diagnoses seen in older children and adults. While a broad differential is listed below, the particular findings of any given case can narrow the differential significantly. Follow up imaging can also help clarify the situation. Unfortunately, I am not aware of an easy mnemonic to help recall these processes. Brute force memory shall have to suffice.

DiseaseNotes
RDSRespiratory distress syndrome
  • preterm
  • ground glass
  • low lung volumes
TTNTransient tachypnea of the newborn 
  • often associated with C-section
  • resolves in 24-48h
MASMeconium aspiration syndrome
  • patchy airspace disease bilaterally
  • increased lung volumes
  • associated with pneumothorax
PNANeonatal pneumonia
  • secondary to group B strep
  • presents with consolidation (round pneumonia - seen in children due to lack of pores of Kohn / canals of Lambert)
PIEPulmonary interstitial emphysema
  • ventilated child
  • lucencies to edge of film
  • associated with pneumothorax
CDHCongenital diaphragmatic hernia
  • gas crossing diaphragm
  • usually presents in postpartum period
  • high mortality rate
  • usually posterior (Bochdalek hernia)
BPFMBronchopulmonary foregut malformation
  • A term that encompasses (see next rows):
  • congenital pulmonary airways malformation 
  • pulmonary sequestration 
  • bronchogenic cyst 
  • neuroenteric cyst 
  • enteric cyst
CPAMCongenital pulmonary airway malformation
  • can fill in and appear consolidative
PSPulmonary sequestration
  • systemic blood supply (aorta)
  • may be cystic
  • intralobar (75%) vs extralobar (has its own pleura - 25%)
BCBronchogenic cyst
  • normal lung tissue without connection to bronchial tree
  • contains fluid (water), variable amounts of proteinaceous material, blood products, and calcium oxalate
  • most common location: mediastinum
NECNeurenteric cyst
  • associated with vertebral anomalies
ECEnteric cyst
  • aka duplication cyst

Each of these entities has a characteristic appearance, which should be studied individually.

Meconium aspiration
Source: Radiopaedia