E2326. Neonatal Chest Imaging: Focusing on Radiography and Ultrasonography
  1. Gayoung Choi; Korea University Ansan Hospital
  2. Bo-Kyung Je; Korea University Ansan Hospital
Chest radiography is the primary imaging modality for evaluation of neonatal lungs. It is an easy and quick modality that provides invaluable information of neonatal chest. However, there are increasing concerns about radiation exposure, especially for the neonates in neonatal intensive care unit (NICU) who undergo repetitive examinations. Ultrasonography (US) enables radiation-free, real-time bedside evaluation of neonatal lungs. In this exhibit, we introduce neonatal chest imaging, focusing on radiography and US.

Educational Goals / Teaching Points
The goals of this exhibit are to understand normal and abnormal findings of lung US and the differential diagnosis of various conditions of neonatal chest by chest radiography and lung US.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Normal lung US (a-lines - horizontal, hyperechoic, equidistant lines parallel to the pleural line, seashore sign (M-mode, motionless horizontal lines of extrapleural structures and normal to- and fro- motion of 'sandy' appearance of lung parenchyma). Abnormal lung US (b-lines - vertical, hyperechoic lines extending from pleura that erase A-lines, indicating interstitial fluid, lung hepatization - lung consolidation [respiratory distress syndrome, pneumonia, atelectasis]). Pathologic conditions on radiographic or US images include transient tachypnea of newborn - streaky infiltration, accentuated fissures / double lung point, pleural abnormality, bilaterality, respiratory distress syndrome - small lung volume, diffuse hazy and granular opacities, air bronchogram / lung consolidation, air bronchogram, pleural abnormality, white lung, bronchopulmonary dysplasia - heterogeneous hyperinflated lungs, patchy coarse opacities / scattered small consolidations, heterogeneous features, meconium aspiration syndrome - coarse, rope-like, linear perihilar opacities / lung consolidation with irregular margins and air bronchograms, and pneumothorax - hyperlucency, visible visceral pleural line / absent lung sliding, stratosphere sign [(M-mode]).

Radiography is the most common and routinely used imaging modality for evaluation of various conditions of neonatal chest. US, which recently became popular in neonatal chest imaging, is helpful for reducing radiation exposure, especially for the neonates in NICU who require repetitive imaging. The performance and interpretation of practical imaging for various neonatal chest conditions can be further improved by coupling of radiography and US.