Presentation
Term neonate. Respiratory distress and difficult ventilation.
Patient Data
The tip of the feeding tube projects over the stomach bubble, well below the left hemidiaphragm.
There is abnormal lucency superior to the cardiac silhouette, with lifting of the thymic tissue bilaterally (spinnaker or angel wing sign). Appearances are consistent with a large pneumomediastinum.
The background lungs demonstrate coarsened airspace opacification, with trace fluid in the right horizontal fissure. No dense consolidation.
Case Discussion
The air leak in the setting of neonatal pneumomediastinum can elevate the prominent (physiological) thymic tissue to create the appearance of a spinnaker (like a sailing boat), or angel wings on the radiograph. The patient was currently undergoing positive pressure ventilation for management of respiratory distress.
The underlying cause for the lung abnormalities in this neonate are unclear, but appearances could reflect transient tachypnea of the newborn or meconium aspiration, depending on the clinical history.
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