Hyaline Membrane Disease

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Severe Chest Retraction Neonate

Figure 1.86. 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 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.

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Metobolic Disorder

Figure 1.87. Comparisons of the clarity of chylous fluid at (a) the age of 4 hours, and prior to feeding, (b) 48 hours and after several milk feeds, and (c) after feeding has been well established. Note the progressive increase in turbidity associated with appearance of fat-laden chylomi-crons after initiation of oral dietary fat intake. Chylous fluid is also high in protein and white blood cells. Management of this infant would include feeds with medium-chain triglycerides and total parenteral nutrition rather than the use of regular formula.

Figure 1.88. A tear in the hypo-pharynx of this infant occurred from erosion by a feeding tube. The tube went through a tear in the hypopharynx into the right pleural cavity (left radiograph). The tube was withdrawn and reinserted the following day, going through the tear into the left pleural cavity (right radiograph). Note the pneumothorax in the right chest in the radiograph on the right. A complication of gastric and endotracheal tube placement is a tear in the esophagus that allows the tube to be placed into the mediastinum, often resulting in a pneumodiorax.

Nasotracheal Tube Pictures
Figure 1.89. These anteroposterior and left lateral decubitus chest radiographs demonstrate a right hydropneumothorax caused by a malpositioned nasotracheal tube that tore through the hypopharynx.
Subcostal And Intercostal Retractions

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Figure 1.90. These twin premature infants with severe hyaline membrane disease developed respiratory distress soon after birth. Note the glistening, gelatinous appearance of the skin due to edema; severe nasal flaring; and intercostal, subcostal, and xyphoid retractions because of the pliability of the chest wall. This reflects die stiffness of the lungs and worsens over the first two to three days. Clinically, the infants have tachypnea with a "see-saw" pattern of breathing and an expiratory grunt.

Figure 1.90. These twin premature infants with severe hyaline membrane disease developed respiratory distress soon after birth. Note the glistening, gelatinous appearance of the skin due to edema; severe nasal flaring; and intercostal, subcostal, and xyphoid retractions because of the pliability of the chest wall. This reflects die stiffness of the lungs and worsens over the first two to three days. Clinically, the infants have tachypnea with a "see-saw" pattern of breathing and an expiratory grunt.

Grunting And Sternal Retraction Newborns

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Subcostal Retraction
Figure 1.91. Severe xyphoid, subcostal, and intercostal retractions are shown in this infant with hyaline membrane disease. The stomach progressively dilates widi swallowed air.

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Figure 1.92. In this infant with hyaline membrane disease, the alae nasi are widely flared, the mouth is open, and there are severe retractions of the sternum and intercostal spaces. These reflect the severity of the respiratory distress. With severe distress, the alae nasi remain open and no flaring is noted. The mouth is open because of the infant's lack of tone and, with improvement in the infant's condition, flaring of die alae nasi is again noted.

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Figure 1.93. This radiograph taken at 20 minutes of age in an infant with mild hyaline membrane disease demonstrates that most of the lung fluid has been cleared. It does not yet reflect the volume loss and consolidation of the lung typical of surfactant deficiency and pulmonary edema.

Figure 1.94. A lateral radiograph of the same infant as in Figure 1.93 shows the sternal retraction, and there is a mild air hronchogram.

Infant Hyaline Membrane Disease

Figure 1.95. Over the ensuing several hours, surfactant deficiency results in severe lung injury with hyaline membrane formation, loss of lung volume, and air bronchograms on the chest radiograph along with the development of a reticulogranular pattern of the lung parenchyma. The reticulogranular pattern consists of diffuse, symmetrical areas of alveolar atelectasis interspersed with aerated bronchioles and alveolar ducts.

Figure 1.96. Hyaline membrane disease is a heterogeneous process involving only some alveoli while others are unaffected. In this instance, a radiograph demonstrates a more severely affected right lung. The typical radiologic appearance of hyaline membrane disease may vary from the typical reticulogranular ("ground glass") appearance of the lung fields with air bron-chograms to complete opacification of the chest.

Imagen Reticulogranular

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Reticulogranular Pattern

Figure 1.97. A detailed view of die left cardiophrenic angle in this radiograph demonstrates the reticulogranular pattern of the lung parenchyma in hyaline membrane disease. With progression of the disease, the reticulogranular pattern becomes more prominent, and coalescence of many of the small atelectatic areas occurs resulting in more opaque lung fields.

Figure 1.97. A detailed view of die left cardiophrenic angle in this radiograph demonstrates the reticulogranular pattern of the lung parenchyma in hyaline membrane disease. With progression of the disease, the reticulogranular pattern becomes more prominent, and coalescence of many of the small atelectatic areas occurs resulting in more opaque lung fields.

Figure 1.98. Lung volume in hyaline membrane disease is progressively lost, resulting in opacification as seen in this radiograph, and can be difficult to recruit again despite the use of vigorous positive pressure ventilation via an endotracheal tube.

1.99

Ground Glass Appearance Hyaline Membrane

Figure 1.99. The appearance of hyaline membrane disease, seen in the radiograph on the left, can be altered dramatically with the application of positive pressure ventilation (radiograph on the right). The application of continuous positive airway pressure (CPAP) can result in a dramatic increase in lung volume and clearing of fluid from the lung fields. (Singleton, E., Wagner, M.)

Figure 1.99. The appearance of hyaline membrane disease, seen in the radiograph on the left, can be altered dramatically with the application of positive pressure ventilation (radiograph on the right). The application of continuous positive airway pressure (CPAP) can result in a dramatic increase in lung volume and clearing of fluid from the lung fields. (Singleton, E., Wagner, M.)

Figure 1.100. Pulmonary interstitial emphysema occurs as a complication in infants with hyaline membrane disease on ventilatory support. This may progress to other manifestations of the airblock syndrome (pneumothorax, pneumomediastinum, etc.). In this radiograph, note die pulmonary interstitial emphysema and pneumothorax on die right. Typically, die "solid lung" of infants with hyaline membrane disease does not collapse if they develop the airblock syndrome. The amount of free air in a pneumothorax may appear to be small because of the inability of the lungs to collapse.

Figure 1.101. These pathologic specimens demonstrate the gross appearance of hyaline membrane disease. The lungs on the left are normal; those on the right are severely affected with hyaline membrane disease. They are cyanotic and engorged with edema fluid and are described as having the consistency and appearance of liver.

Figure 1.100. Pulmonary interstitial emphysema occurs as a complication in infants with hyaline membrane disease on ventilatory support. This may progress to other manifestations of the airblock syndrome (pneumothorax, pneumomediastinum, etc.). In this radiograph, note die pulmonary interstitial emphysema and pneumothorax on die right. Typically, die "solid lung" of infants with hyaline membrane disease does not collapse if they develop the airblock syndrome. The amount of free air in a pneumothorax may appear to be small because of the inability of the lungs to collapse.

Hyaline Membrane Disease

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Pregnancy Diet Plan

Pregnancy Diet Plan

The first trimester is very important for the mother and the baby. For most women it is common to find out about their pregnancy after they have missed their menstrual cycle. Since, not all women note their menstrual cycle and dates of intercourse, it may cause slight confusion about the exact date of conception. That is why most women find out that they are pregnant only after one month of pregnancy.

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