Presentation
Profound hypoxia despite maximal ventilatory support.
Patient Data
Multiple mediastinal lines and tubes in a neonate (confirmed by umbilical lines). It is important to be aware of what these lines are and where they should be. It's always worth considering lines and tubes first when reviewing any radiograph.
- airway (turquoise)
- ECMO x2 (light blue)
- NG (yellow)
- temperature (purple)
- UAC (red)
- UVC (blue)
- left ICC (green)
Case Discussion
It's always worth identifying all lines and tubes, especially on ITU/NNU chest radiographs before embarking on the rest of the film.
The lines and tube, include in ECMO catheters are in appropriate positions. The background lungs demonstrate interstitial opacification, but no confluent consolidation or collapse and no significant residual effusion.
The differential for the background lung disease is wide and includes cardiac failure, infection and inflammatory causes. Since this child is only 3 day old, TTN is a possibility. However, the ventilatory failure is profound despite a relatively benign looking chest radiograph.