554

Menkes Kinky Hair Syndrome

A close-up of the baby shows the typical facial features of high, narrow forehead, puffy eyelids, inner epicanthic folds, low nasal bridge, anteverted nostrils, a long philtrum, and progressive hypertrophy of the alveolar ridges. Figure 5.55. Radiograph of the lower extremities in Leroy I-cell disease shows discrete metaphyseal bands at the distal ends of the long bones. Menke's kinky-hair syndrome (steely-hair syndrome trichopi-lodystrophy). Note the failure to thrive, and the...

514

Vestigial Tail Deformity

This infant with congenital hyperthyroidism had a large midline neck mass due to a congenital goiter. Congenital goiter can occur when there is a defect in the synthesis of thyroid hormone (due to fetal TSH stimulation causing intrauterine growth of the thyroid gland) or in cases of maternal hyperthyroidism (due to long-acting thyroid stimulator LATS ) antibody crossing the placenta. Figure 5.13. This infant with congenital hyperthyroidism had a large midline neck mass due to a...

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Pictures Bulging Flanks

Sagittal section of an infant's kidney showing severe medullary hemorrhage secondary to hypoperfusion. Figure 4.23. Autopsy specimen of the right kidney and adrenal gland in an infant who died from early onset group B streptococcal sepsis widi disseminated intravascular coagulopathy. There is a massive adrenal hemorrhage which completely destroyed the adrenal gland by hemorrhagic necrosis. Note the normal kidney with fetal lobulation and the markedly enlarged adrenal gland. Figure...

2110

Abdominal Wall Edema

Following perforation of the bowel and resulting peritonitis, diis infant developed marked abdominal distention and edema of the abdominal wall. This may occur in an infant with a perforated viscus or in low birdiweight infants widi necrotizing enterocolitis. Figure 2.110. Following perforation of the bowel and resulting peritonitis, diis infant developed marked abdominal distention and edema of the abdominal wall. This may occur in an infant with a perforated viscus or in low...

Ascites In Small Babies

Infant Diabetic Mother

Thirty-three week gestational age infant with severe intrauterine growth retardation. This Hispanic infant was born at 33 weeks gestational age. There was oligohydramnios with severe intrauterine growth retardation (birth weight 1088 g). There was marked generalized hyperpigmentation of the skin (mother is holding infant) at age 4 weeks. This infant developed adrenal failure at 1 week of age, and the diagnosis of a primary adrenal hypoplasia was confirmed. The infant responded well...

533

Ambiguous Genitalia Female

Hispanic female infant with ambiguous genitalia as a result of 21-hydroxylase deficiency. Infant presented on the 8th day of life with a serum potassium of 10 mEq dL and a serum sodium of 108 mEq dL due to congenital adrenal hyperplasia. Note die cli-toromegaly and marked increase in pigmentation. Karyotype was 46 XX. Figure 5.33. Hispanic female infant with ambiguous genitalia as a result of 21-hydroxylase deficiency. Infant presented on the 8th day of life with a serum potassium...

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Constipation And High Blood Pressure

Torsion of die left testis which was present at birth. The left side felt firm and tender and there was purplish scrotal discoloration which did not cross the midline. The testicular scan may show the characteristic bull's eye sign of the vascular supply. With the advent of ultrasonography, the diagnosis is readily confirmed and a scan is not required. This represents a surgical emergency, but the testis usually sustains too much vascular compromise and cannot be salvaged. Figure...

65

Slate Grey Color Baby Methemoglobinemia

Petechiae on the forearm of an infant following severe birth asphyxia. The infant's platelet count was 90,000 mm3 and returned to normal within a week. Figure 6.8. Note the slate gray discoloration of the skin in an infant with methemoglobinemia at die age of 9 days. Total hemoglobin was 10.4 gm dL with 11 methemoglobiii. The infant had been treated with intravenous nitrofurantoin for a urinary tract infection. There are many causes of methemoglobinemia in the neonate (see this...

Images Of Pseudohermaphrodites

Images Pseudohermaphrodites

Micropenis with a normal scrotum in an infant who presented with severe hypoglycemia. This combination should alert one to the diagnosis of hypopituitarism. There is a higher incidence of hypopituitarism in patients with a variety of midline defects. Hypopituitarism was confirmed in this infant. Figure 5.20. This female infant has ambiguous genitalia. The karyotype was XX. Difficulties in determining the sex of an infant may arise from abnormalities of the external genitalia....

63

In infants with a feto-maternal hemorrhage, the Kleihauer-Betke test on maternal blood is positive as shown in diis microscopic slide. Acid elution of maternal hemoglobin results in lysis of the red blood cells (creating ghost erythrocytes), while fetal red blood cells resist acid hydrolysis. Figure 6.3. At the age of 3 days, this infant developed hematuria and bloody stools as a result of hemorrhagic disease of the newborn. This is due to a transitory prothrombin and vitamin K...

Congenital Hypothyroidism In Infants

Facial Puffiness Hypothyroidism

Left, radiograph of the long bones of the lower extremity in a term infant with congenital hypothyroidism. Note the lack of the ossification centers. The distal femoral ossification center usually appears at 36 weeks gestational age and the proximal tibial ossification center usually appears at 38 weeks gestational age. Right, lateral radiograph of the neck of the same infant showing the presence of a large congenital goiter which caused severe respiratory distress. Figure 5.2....

Hematology Jaundice and Oncology

The neonate may suffer from hematologic conditions involving the erythrocyte, platelet, leukocyte, coagulation, and thrombosis. Many of these disturbances are life-threatening, some are primary, and some reflect other diseases. Jaundice is a common problem in the neonate, and it is rarely life-threatening or debilitating. It is of particular concern, because it frequently occurs in otherwise healthy infants, usually because the liver cannot clear sufficient bilirubin from the plasma. Neoplasias...

Vaginal Deformities

Vaginal Deformities

The mass is raised superiorly in the same infant as in Figure 4.37 to demonstrate a normal vaginal introitus. Gonzalez, E. Figure 4.38. The mass is raised superiorly in the same infant as in Figure 4.37 to demonstrate a normal vaginal introitus. Gonzalez, E. Figure 4.39. Gentle traction on the urethra of the same infant as in Figures 4.37 and 4.38 delineates the association of the cystic mass arising from the floor of the urethra. Gonzalez, E.

Newborn Female Normal Genital

Newborn Abnormal Genitalia

Another example of exstrophy of the bladder in a male infant who had meningomyelocele and developed an associated arthrogryposis. Figure 4.127. Another example of exstrophy of the bladder in a male infant who had meningomyelocele and developed an associated arthrogryposis. Figure 4.128. The cloacal dysgenesis sequence which represents a complete urogenital sac defect with a vesicointestinal fissure resulting from abnormal development of the lower half of the abdominal wall.

Melena Neonatorum

Fetal Hemoglobin

The Apt test diagnoses melena neonatorum caused by ingested maternal blood see inset . Fetal hemoglobin in the presence of alkali remains pink and is not denatured. Adult hemoglobin in the presence of alkali denatures and changes to a yellow-brown color. Note the inset with adult hemoglobin on the left and fetal hemoglobin on the right. Figure 2.97. The Apt test diagnoses melena neonatorum caused by ingested maternal blood see inset . Fetal hemoglobin in the presence of alkali...

Baby Testicle Swollen And Blue

Discolored Testicles

Large bilateral hydroceles in a premature infant with a normal-sized penis. In infants with hydrocele of the spermatic cord, the swelling is also noted in the groin and thus a hydrocele of the cord must be distinguished from an inguinal hernia. Figure 4.73. Transillumination of bilateral hydroceles in a term infant. In the case of an indirect hernia, transillumination is negative. Figure 4.74. Massive bilateral inguinal herniae in a 10-week-old weight 1900 g premature infant with a...

1126

Hyaline Membrane Disease

This infant with severe hyaline membrane disease developed severe diffuse bilateral pulmonary interstitial emphysema PIE . Clinically, it behaves like other types of airblock-producing hyper-carbia initially widi hypoxemia and systemic hypotension when severe. The heart may be compressed by severe bilateral pulmonary interstitial emphysema. Systemic venous return and cardiac output may be severely compromised, resulting in a small heart shadow on chest radiograph. Loose connective...

Skin Tag On Perineum Female

Long Perineum

Anal skin tags are small outgrowths of the mucosa arising from the anal margin. They are relatively common and have no pathologic significance. Figure 2.79. Anterior placement of the anus in an infant. This occurs when there is an abnormality of fusion between the urorectal septum and the cloacal membrane. If there is inadequate development of die urorectal septum and if its junction with the cloacal membrane is too far anteriorly, the anus is displaced forward and may open...

Infant Megalopenis

Penile Skin Conditions

If there is a markedly enlarged penis and bifid scrotum, the diagnosis of megalopenis and megalourethra should be considered. In the more common variety of this unusual anomaly, the corpus spongiosum is absent and the abnormally large penis has a scaphoid shape. The upturned glans penis is normally formed and the urethral meatus is normal in site and in size, without demonstrable obstruction to voiding. Figure 4.116. In this infant with a markedly enlarged penis and urethra...

Imperforate Anus

Cloacal Deformities

A urogenital sac defect which resulted in cloacal dysgenesis with anterior placement of the anus is present in this female infant. The features of cloacal dysgenesis include omphalocele, bladder exstrophy, and a blind colon which is associated with anorectal agenesis. Figure 4.130. Ambiguous genitalia in a female infant with VACTERL syndrome. Note the cloacal sac with a single urogenital opening. The bladder is in free communication with the rectum. This infant also had congenital...

Nutritional Disorders

Intrauterine Growth Retardation Pictures

The gastrointestinal tract of the newborn must process a relatively large amount and variety of foods soon after birth. The average term infant takes about 540 cc 18 ounces of food daily by two weeks of age. In adults, correcting for body surface area, this would equal approximately 10 liters of fluid per day. In proportion to its size, the premature infant processes an even greater load. The infant's diet must contain the appropriate quantity of protein, carbohydrates, fats, minerals,...

Female Genital Abnormalities

Glans Foreskin Fusion

A premature infant with a glanular hypospadias and chordee in the act of voiding. Note that the chordee results in a stream of urine always pointing downward, hence the importance of correcting this defect. Note the normal appearance of the developing premature scrotum. Figure 4.103. Glanular hypospadias with a hooded prepuce incomplete foreskin with chordee. Note that the whole ventral surface of the glans is uncovered, with prepuce covering only the dorsum of the glans like a...

Metabolic Syndrome And Big Stomach

Abdominal Wall Muscle Rupture

The intravenous pyelogram in this infant shows a left-sided ureterovesical obstruction resulting in a left hydroureter and severe left hydronephrosis. The radiograph was taken 3 hours after injection of the dye. Note that the calyceal pattern on the right side is normal and the bladder is not very enlarged. Hydronephrosis in the newborn is most commonly due to obstruction at the bladder neck or at the ureterovesical junction. With the advent of ultrasonography, intravenous...

Abnormal Vaginal Opening

Cliteromegaly Newborn

Another example of incomplete testicular feminization. Note the hypospadias. Karyotype was XY. In the syndrome of testicular feminization, the infants are genetic males testes are located in the inguinal canal or in the labial folds. The external genitalia are female in configuration, and occasionally the clitoris is slightly enlarged labioscro-tal folds are partially fused and characteristically there is a blind vaginal pouch. The uterus may be rudimentary or absent. Incomplete...

Neonate Disease

Gross Bloody Poop

Contrast radiograph of an infant with a sigmoid volvulus. Note the failure of passage of barium into the descending and transverse colon with proximal dilated air-filled loops. It occurs as a result of a mesenteric abnormality in which the bowel is not attached to the posterior abdominal wall except at the duodenum and proximal colon. Consequently, the bowel may twist on itself resulting in obstruction and possible gangrene. Singleton, E., Wagner, M. Figure 2.86. This infant...

Clitoris Newborn

Infant Genitalia

Penile agenesis with anterior displacement of an empty scrotum. The urethra appears at the top of the scrotal raphe. Agenesis of the phallus occurs as a result of failure of formation of the genital tubercle. The scrotum is usually present but may lack rugae, and descent of die testes is variable. This malformation has been reported most commonly in sirenomelia. Figure 4.111. This infant presented with severe hypoglycemia and a micropenis with a normal scrotum. The diagnosis of...

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Ureters Women

An abdominal radiograph of an infant with hydrometrocolpos. Note the superior and lateral displacement of the normal loops of bowel and the associated central opacification due to the enlarged uterus. Diagnosis is confirmed by examining the vagina. Figure 4.61. Contrast dye study in the same infant as in Figure 4-60 with hydrometrocolpos. Note the outline of the enlarged uterine cavity. This can cause pressure on the ureters, resulting in hydroureter and hydronephrosis. Figure...

Toddler Genitalia

Female Genitalia Deformity

Marked abdominal distention in an infant with massive polycystic kidneys. This infant died soon after birth. Infants with polycystic kidneys typically have an autosomal dominant pattern of inheritance in contrast to the autosomal recessive pattern in adult polycystic kidney disease. If little urine is produced, the fetus may exhibit the Potter sequence with fetal compression and pulmonary hypoplasia. Figure 4.14. Radiograph taken 24 hours after contrast medium was given for an...

4135

Exstrophy Cloaca Sequence

This female infant has exstrophy of the cloaca sequence which includes cloacal exstrophy with imperforate anus, ambiguous genitalia, and a lumbosacral myelocystocele hydromelia . In addition to the exstrophy, the urinary tract may be involved by various anomalies such as hydronephrosis or cystic or absent kidney. Figure 4.135. Another example of the exstrophy of the cloaca sequence. Note the exstrophy of the cloaca and hydromelia. This infant also developed an in utero amputation...

Genitourinary System

Oligohydramnios Causes

The genitourinary system excretes waste products, helps maintain fluid and electrolyte balance, and is the basis for later normal sexual development. Anatomic malformations of this system may be numerous and include the kidneys, ureters, bladder, urethra, or external and internal genitalia. Normally, the fetus is able to urinate into the amniotic sac by 10 weeks gestation. Maternal oligohydramnios may indicate that this is not occurring, and suggests an obstruction of the fetal genitourinary...

275

Rectal Disorders

Radiograph of the autopsy specimen seen in Figure 2.73, showing die calcified colonic contents popcorn appearance . Langston, C. Figure 2.76. This infant presented with a patulous appearance of the anal sphincter. This may denote an abnormality of the innervation to the perineum. On rectal examination an obstruction was detected approximately 1 cm from the anal orifice as the result of an imperforate anal membrane. Figure 2.76. This infant presented with a patulous appearance of...

Bronchopulmonary Dysplasia

Bronchopulmonary Dysplasia

The characteristic hair changes are compared. Note the head of a normal infant, one with patchy alopecia, and one with gray and atrophic hair. Figure 3.9. A 6-week-old premature infant birth weight 1400 g developed marked hyperpigmentation and desquamation of the skin while in the nursery. She was being treated for bronchopulmonary dysplasia with oxygen by cannula and receiving peripheral parenteral nutrition. Her condition improved when trace elements were added to her diet. Figure...

Hydrocele In Infants

Empty Scrotal Sac

This infant has a torsion of the right testis. Note the purplish-blue appearance of the right testis which was firm and tender. The testis usually rides high with a torsion. The infant has a hydrocele on the left side. Torsion can lead to irreversible damage of the testis within 6 hours of the occurrence. Testicular salvage is almost unheard of because the torsion often occurs prena-tally during the process of testicular decent. Figure 4.81. This infant has a torsion of the right...

Blind Vaginal Pouch

Congenital Adrenal Hyperplasia Genitalia

The same infant as in Figure 4.120 with rhabdomyosarcoma, showing the abnormal appearance of the glans and foreskin. Figure 4.122. Ambiguous genitalia in a monozygotic female twin infant the other twin was normal . There is imperforate anus and a blind vaginal pouch. This is an example of a doughnut scrotum which encircles the phallus. It is a form of penoscrotal transposition and is not of great consequence. This should be distinguished from a shawl scrotum which appears to...

Toddler Abnormal Clitoris

Prominent Labia Minora Newborn

Abnormal female genitalia in this infant with prominent labia minora, clitoral enlargement, and anterior placement of the anus. Hypoplasia of the labia majora may give rise to the false impression of a large clitoris. Figure 4.48. Abnormal female genitalia in this infant with prominent labia minora, clitoral enlargement, and anterior placement of the anus. Hypoplasia of the labia majora may give rise to the false impression of a large clitoris.

Do Cysts Spontaneously Resolve In Male Infants

Foreskin Retraction Toddlers

A right-sided ectopic scrotum with left hemiscrotum in an infant with the popliteal pterygium syndrome. The scrotum is thus divided and there is cryptorchidism on the right. The testis is palpable on the left side. Figure 4.91. A right-sided ectopic scrotum with left hemiscrotum in an infant with the popliteal pterygium syndrome. The scrotum is thus divided and there is cryptorchidism on the right. The testis is palpable on the left side. Figure 4.92. In this male infant there is a...

Small Penile Syndrome Pictures

Infant Scrotums Pictures

Bilateral cryptorchidism in a term infant with a normal penis. Note the empty scrotal sacs and the median raphe which traverses the underside of the penile shaft and scrotum. Babies of die youngest gestational ages have the highest rate of undescended testes or cryptorchidism. Even at term, about 3 of male infants have an incompletely descended testis on one side nearly twice as often on die right as on the left . The majority descend within the first year. Figure 4.85. Bilateral...

Toddler Vaginal Secretions

Picture Toddler Vaginal Discharge

Normal mucoid vaginal discharge in a normal female infant. This results from the withdrawal effect from the in utero environment. Figure 4.44. Withdrawal bleeding in a normal female neonate. Vaginal bleeding is not uncommon in the first week of life. It is caused by die withdrawal of die high maternal estrogen level to which the baby has been exposed in utero. Vaginal bleeding is self-limited in diat transplacental hormone withdrawal effect starts on the third to fourth day of life...

Clitoris Bruised

Bruised Child Labia Minora

The genitalia of the normal female infant gape, partially revealing the labia minora and, perhaps, the clitoris. The labia majora are full, and the thickened labia minora protrude between them. The mucosa normally is pink and a mucoid vaginal secretion is common. Figure 4.41. Normal external female genitalia in a premature infant. Note the prominence of the labia minora. The clitoris is large in preterm babies with the result that the inexperienced physician may suspect ambiguous...

What Causes Hydrometrocolpos And It Remedies

Infant Genitalia

Involvement of Bartholin's gland is extremely rare in the neonate. This infant at the age of 2 weeks developed a Bartholin's cyst abscess. Figure 4.56. Involvement of Bartholin's gland is extremely rare in the neonate. This infant at the age of 2 weeks developed a Bartholin's cyst abscess. Figure 4.57. This infant presented with a swelling in the vagina. On the left note die typical appearance of a hydro-colpos. On die right, the use of the blunt end of a cotton tip swab...

Imperforate Hymen

Vagina Disorders

Upright radiograph of an infant with meconium peritonitis associated with perforation of the colon and pneumoperitoneum. Also note the diffuse calcification especially over die area of the liver. Figure 2.56. Surgical appearance of meconium peritonitis. Note the areas of calcification over the liver and in the peritoneal cavity. Figure 2.56. Surgical appearance of meconium peritonitis. Note the areas of calcification over the liver and in the peritoneal cavity. Figure 2.57. This...

Anus Inspection

Bloody Anus

Bloody stools in this otherwise normal infant at the age of 48 hours were not caused by ingested maternal blood. Differential diagnosis includes infection, necrotizing enterocolitis, and anal fissure. Etiology was not determined and the infant did well. Figure 2.94. This premature infant with no symptoms at 3 weeks presented with blood in the stool. Note that the blood is not mixed in the stool. Inspection of the anal mucosa revealed fissures which caused the presence of blood in...

Massive Liver Enlargement

Liver Hemangiomatosis Newborn

Marked abdominal distention in an infant with multiple hemangiomatosis. The abdominal distention was due to massive enlargement of the liver. This infant also had numerous hemangiomas of the skin. Figure 2.146. Marked abdominal distention in an infant with multiple hemangiomatosis. The abdominal distention was due to massive enlargement of the liver. This infant also had numerous hemangiomas of the skin. Figure 2.147. The multiple massive hemangiomas involving the liver are noted...

Prolapsed Cervix

Abnormal Size Penis

Mild procidentia prolapse of the uterus in an otherwise normal newborn. Figure 4.64. This neonate has a severe procidentia prolapse of the uterus to such a degree that the cervix protrudes from the vaginal outlet. The infant had an associated meningomyelocele. Procidentia in the newborn is almost invariably associated with neural tube defects. Figure 4.65. In this infant there is duplication of the external genitalia. Note the two vaginal orifices. Duplication of the external...

Umbilical Granuloma

Omphalocele

Umbilicus amnioticus or amniotic navel innie in an infant at the age of 5 days. This is less common. The amniotic portion of the umbilical cord extends to the abdominal wall and this results in a true belly button. Figure 2.127. Superior and lateral view of umbilicus cutis in another infant. Outies or skin navels are more common in black infants. This protrusion is not reducible in contrast to infants with umbilical herniae. Umbilical herniae arise due to separation of the rectus...

269

Rectum Infant

Imperforate anus with a rectovaginal fistula. The large fistulous tract allows for free passage of meconium hence this infant had no abdominal distention. Figure 2.67. Imperforate anus with a rectovaginal fistula. The large fistulous tract allows for free passage of meconium hence this infant had no abdominal distention. Figure 2.68. Radiograph of an infant widi imperforate anus. The Wangensteen technique for diagnosis of high or low location of an imperforate anus places the...

Windsock Deformity Duodenum

Transverse Colon Colonostomy

Anteroposterior and lateral radiograph showing a lactobezoar in an infant with die inspissated milk syndrome. Figure 2.20. Anteroposterior and lateral radiograph showing a lactobezoar in an infant with die inspissated milk syndrome. Figure 2.21. Duodenal atresia observed clinically in an infant at the age of 6 hours. Note the dilated stomach and dilated proximal duodenum giving rise to the double bubble appearance. At this early age, the infant also has a scaphoid lower abdomen....

162

Congenital Lobar Emphysema Fluid

Antero-posterior and lateral chest radiographs in an infant with congenital lobar emphysema of the upper lobe of the right lung. Right upper lung lobe involvement occurs in 20 of the cases. Note the hyperinflated right hemithorax with the lack of vascular markings and the displacement of the mediastinum to the left. Figure 1.62. Antero-posterior and lateral chest radiographs in an infant with congenital lobar emphysema of the upper lobe of the right lung. Right upper lung lobe...

Rectus Abdominis Separation

Rectus Abdominis Separation With Hernia

Diastasis recti divarication of die recti muscles in a term infant. This is a widened space between die rectus abdominis muscles. Lying between die umbilicus and the xiphoid process, it presents as a bulge especially with straining or crying. Varying degrees of separation may be found in nomal infants. Figure 2.12. Diastasis recti divarication of die recti muscles in a term infant. This is a widened space between die rectus abdominis muscles. Lying between die umbilicus and the...

Bile Stained Vomitus

Bile Vomit Obstruction

Contrast study more clearly delineates the abnormal pouch. This procedure is often not needed and carries increased risk. Note the communication with spillage of barium into the respiratory tract as an excessive amount of contrast was used. This aspiration of contrast into die lungs via the tracheoesophageal connection is typical of type C and D tracheoesophageal fistulae, but can occur with any type. Figure 2.8. Contrast study showing the typical H-type fistula type B...

Gastrointestinal System

Esophageal Atresia Newborn

The gastrointestinal tract absorbs and digests nutrients, maintains fluid and electrolyte balance, and protects the newborn from pathogens and toxins. Anatomic malformations of this system may be numerous and affect the pharynx, diaphragm, esophagus, stomach, small or large bowel, pancreas, liver, and spleen. The development of the gastrointestinal system is in close proximity and timing to the development of the respiratory and urogenital systems, and frequently malformations occurring in...

1182

Ectopia Cordis

In this stillborn infant with ectopia cordis, the heart lies outside the thoracoab-dominal wall. The heart typically has severe defects, such as in this case, with tetralogy of Fallot, secundum atrial septal defect, persistent left superior vena cava, and absent ductus arteriosus. Figure 1.181. In the same infant as in Figure 1.180, the diagnosis of diverticulum of the left ventricle was confirmed by angiogram. Figure 1.182. In this stillborn infant with ectopia cordis, the heart...

Ebstein Anomaly In Newborns

Histiocytosis Skin

Reticuloendothelioses or histiocytosis X represents a variety of conditions which show clinical and pathologic overlap. There is a spectrum of widely disseminated monoblastic leukemia formerly called Letterer-Siwe disease. The lung is involved in only 2 of all cases. In this chest radiograph, note the bilateral lung nodules. Figure 1.163. Congenital generalized fibromatosis can involve the skin, subcutaneous tissue, muscle, bone and visceral organs. The radiograph on die left...

Congenital Lobar Emphysema

Congenital Lobar Emphysema Newborn

Congenital lobar emphysema most commonly involves the left upper lobe of the lung 47 . In general, the distribution is slightly greater in the right lung than in the left. The left upper lobe in this infant is hyperinflated and displaces the mediastinum to the right. The left hemithorax is larger than the right, but the absence of increased pulmonary vascular markings on the left and respiratory distress suggests the diagnosis of congenital lobar emphysema. Singleton, E., Wagner,...

Hyaline Membrane Disease

Infant Hyaline Membrane Disease

The same infant as in Figure 1.84 and 1.85 later required a second thoracentesis at the age of 48 hours. In diis chest radiograph following aspiration of the chylodiorax, a subcutaneous collection of air and a small residual pneumothorax persisted. Figure 1.85. Radiograph of the same infant as in Figure 1.84 at the age of eight hours, following thoracentesis at the age of 4 hours. Note marked improvement, although some fluid is still present. Figure 1.86. The same infant as in...

Bilateral Pulmonary Hyperaeration

Air Embolism Newborn

Bilateral pulmonary interstitial emphysema in another infant in which the radiograph shows the typical findings of hyperinflation and diffuse hyperlucencies within the lung parenchyma. This complication of hyaline membrane disease occurs most commonly as a complication of mechanically assisted ventilation and rarely occurs spontaneously. There is widespread rupture of alveoli resulting in accumulation of air in the interstitial lung tissue. Figure 1.128. Bilateral pulmonary...

Persistent Pulmonary Hypertension

Meconium Aspiration Syndrome

The sequelae of meconium aspiration syndrome are noted in this radiograph. There are areas of infiltrate and blebs seen in the right lung field. Pneumothorax and pneumomediastinum are common complications. Figure 1.109. Meconium pneumonitis can occur when aspirated contents cause chemical inflammation of portions of the lung, resulting not only in hyperinflation from obstruction of airways but in patchy interstitial infiltrates extending out to the periphery. In meconium...

Diaphragm Paralysis

Transient Tachypnea Newborn

In this infant with a unilateral paralysis of the right diaphragm, note the elevation of the ribs on the affected side of the chest. The chest is asymmetrical and, with inspiration, chest expansion occurred only on the normal side. In general, this condition is functional and may resolve spontaneously. Figure 1.79. In this infant with a unilateral paralysis of the right diaphragm, note the elevation of the ribs on the affected side of the chest. The chest is asymmetrical and, with...

Meconium Aspiration

Meconium Aspiration Syndrome

This photomicrograph shows hyaline membrane formation and edema fluid within the alveolus. The surrounding alveoli are thickened and atelectatic. Hyaline membranes are proteinaceous exudate from injured type I alveolar cells not lined with surfactant. The lack of surfactant represents immaturity of the type II alveolar cell. Figure 1.103. Transient tachypnea of the newborn wet lung syndrome may occur at all gestational ages most common in term infants and must be differentiated...

Chlamydia Pneumonia

Chlamydia Pneumonia Infant

A radiograph of the chest of an infant with congenital syphilis demonstrates the typical interstitial pneumonia pneumonia alba and the osseous changes of growth arrest lines at the proximal ends of the humeri and periostitis of the clavicles Higoumenakis' sign . Figure 1.121. A radiograph of the chest of an infant with congenital syphilis demonstrates the typical interstitial pneumonia pneumonia alba and the osseous changes of growth arrest lines at the proximal ends of the humeri...

1116

Staph Aureus Pneumonia Pneumatocele

This radiograph is another example of group B streptococcal pneumonia indistinguishable from hyaline membrane disease. Only 50 of blood cultures are positive with congenital pneumonia. The diagnosis of group B streptococcal pneumonia was suggested by a positive tracheal aspirate and urine counterimmune electrophoresis CIE . Figure 1.115. Neonatal pneumonia is most commonly caused by group B Streptococcus, but can be due to Escherichia coli, Staphylococcus aureus, or Listeria...

Scaphoid Abdomen

Scaphoid Abdomen Diaphragmatic

Radiograph of another infant with congenital cystic adenomatoid malformation of the lung on the left side. This infant developed increasingly severe respiratory distress within 18 hours of birth as a result of progressive air trapping and hyperinflation. In these infants, surgical removal of the malformation is essential. Congenital cystic adenomatoid malformation may present initially as an intrapulmonary mass which appears solid or has a few scattered translucent areas, but this...

Metabolic Disorders

Large Thymic Shadow

The same infant showing the Pierre Robin sequence micrognathia, macroglossia, a protruding tongue, and a cleft palate which is often posterior. Cyanosis is often due to the tongue falling back and obstructing the posterior oropharynx. The infant should be managed in a prone position to avoid breathing problems. Micrognathia improves significantly over time. Figure 1.20. Mandibular hypoplasia, a small underdeveloped mandible, can be an isolated finding or part of a sequence such as...

Does Vascular Ring In Infants Cause Spit Up

Normal Bronchogram Infants

In the extremely rare condition of tracheal agenesis, the trachea and esophagus arise from the endoderm of the laryngotracheal tube. Note the communication that abnormally persists between these two structures. Figure 1.44. This radiograph depicts a swallowed cuffed endotracheal tube in the stomach. Attempts to resuscitate this infant by endotracheal intubation by the physician in attendance at delivery were unsuccessful. Leaving the tube in place, he called for assistance and the...

Cardiorespiratory System

Pithed Frog Position

Following birth, the function of gas exchange is transferred from the placenta to the lungs. Oxygen supply to the newborn infant depends upon the establishment of rhythmic breathing, expansion of the lungs with air, adequate pulmonary blood flow to pick up oxygen from the lungs, and systemic blood flow to transport oxygen to the tissues. Normal respiration requires that the central and peripheral nervous systems involved in breathing are appropriately developed, that respiratory muscle...