PMC6467035_01
Anteroposterior radiograph of the chest showing granular opacities in both lungs consistent with Respiratory distress syndrome
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F1
Initial radiograph showed bilateral diffuse hazy granular opacities suggesting respiratory distress syndrome (RDS) [Figure 1].
(A) Anteroposterior radiograph of the chest, 2 hours after birth shows development of pneumopericardium/pneumomediastinum (black arrows). (B) Anteroposterior radiograph one hour following the radiograph in Figure 2A, shows enlargement of the pneumopericardium/pneumomediastinum
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F2
Subsequently the serial radiographs showed enlarging pneumopericardium/pneumomediastinum [Figure 2A and B].
(A) Suprasternal notch imaging plane. Echobright imaging artifact consistent with air in the superior mediastinum (arrows). INN; innominate vein, I; first branch of aortic arch, II; second branch of aortic arch and III; third branch of aortic arch. (B) Subcostal imaging plane demonstrating echobright artifact consistent with air along the left ventricular free wall (arrows). RV; right ventricle, IVS; interventricular septum, LV; left ventricle
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F3
An echocardiogram was performed, which confirmed presence of pneumopericardium/pneumomediastinum. [Figure 3A and B].
Sagittal ultrasound of the chest in the region of the right lower chest, showing dirty shadowing consistent with air echoes (white arrows)
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F4
Ultrasonographic guided drain placement for pneumopericardium/pneumomediastinum was performed as follows; with the patient in the supine position, a hockey stick transducer (15 MHz) was placed on the right anterior chest wall along the long axis of the ribs in the expected location of the pneumopericardium/pneumomediastinum [Figure 4], as correlated with the radiograph.
Anteroposterior (A) and lateral (B) radiographs of the chest, after advancing a Bentson wire (black arrows), shows the wire in good position coursing through the pericardial/mediastinal space
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F5
At this point portable anteroposterior and lateral radiographs were obtained at the patient's bed side to confirm wire localization [Figure 5A and B].
Anteroposterior radiograph with pericardial drain placement shows near complete evacuation of the pneumopericardium/pneumomediastinum. The drain is located in the right side of the heart/mediastinum (black arrow)
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F6
Another radiograph was obtained to confirm the position [Figure 6].