February 1986

Radiological Case of the Month

Author Affiliations

Contributed from the Department of Paediatrics and Neonatal Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, London. Dr Placzek is presently at the Children's Hospital, Western Bank, Sheffield, England.

Am J Dis Child. 1986;140(2):161-162. doi:10.1001/archpedi.1986.02140160079039

A male infant with a birth weight of 2,550 g, was born by spontaneous vaginal delivery at 36 weeks' gestation following an uneventful pregnancy. Apgar scores were 5 and 8 at one and five minutes, respectively. Idiopathic respiratory distress syndrome developed in the patient, and he required intubation and mechanical ventilation from 6 hours of age. A chest roentgenogram was done (Fig 1). At 4 days of age, ventilatory requirements increased: with a forced inspiratory oxygen of 0.85 and ventilation at 60 breaths per minute with inspiratory and expiratory pressures of 20 and 3 cm H2O, respectively. A repeated chest roentgenogram was obtained (Fig 2). Selective intubation of the right main bronchus was performed using a size 3.0-noncuffed endotracheal tube. Within two hours of selective intubation of the right main bronchus, the forced inspiratory oxygen requirement had fallen to 0.55, and ventilation pressures were subsequently reduced. Twenty-four hours

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