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September 1986

Radiological Case of the Month

Am J Dis Child. 1986;140(9):903-904. doi:10.1001/archpedi.1986.02140230073035

A 1.05-kg female infant was born at 29 weeks' gestation by emergency cesarean section. The Apgar scores were 6 and 8 at one and five minutes, respectively. The infant was intubated and subsequently ventilated with a fraction of inspired oxygen of 0.7 (maximum, 0.8) at an initial rate of 44 breaths per minute (maximum, 68 breaths per minute) and pressure of 25/2 cm H2O (maximum, 30/3 cm H2O). Her initial chest roentgenogram was compatible with severe idiopathic respiratory distress syndrome (IRDS), with a complete "whiteout" of both lungs. For the first seven hours she was stable, but then her condition deteriorated, and a chest roentgenogram at that time showed the development of severe pulmonary interstitial emphysema (PIE) in the right lung. Prophylactic chest drains in the right hemithorax were inserted, but the general condition continued to worsen. A chest roentgenogram at 12 hours showed bilateral PIE,

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