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Chest imaging in newborns and children

In the newborn, distinguish by lung volume and opacity pattern: RDS in a preterm infant (low volume, granular, symmetric), TTN in a term infant (fluid in the fissures, resolving within days), meconium aspiration (hyperinflation and patches) — and in the child look for a foreign body, "round pneumonia" and congenital malformations.

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Why it matters in the exam

RDS (surfactant deficiency) in a preterm infant: low lung volume, diffuse symmetric granular opacity with air bronchograms. TTN — a term infant, usually after caesarean section: normal or increased volume, fluid in the fissures, a small effusion and hilar congestion, resolving within 24–72 hours. Meconium aspiration — a post-term infant: hyperinflation, asymmetric opacities and a risk of pneumothorax. Neonatal pneumonia (usually GBS) can look like RDS, sometimes with an effusion. Positive-pressure ventilation causes air leak: interstitial emphysema, pneumothorax and pneumomediastinum. Congenital diaphragmatic hernia — usually left and posterior (Bochdalek): bowel loops and the nasogastric tube in the chest, mediastinal shift and pulmonary hypoplasia.

CPAM — a multicystic air-filled lesion supplied by the pulmonary artery; sequestration — lung tissue supplied by a systemic artery from the aorta, usually in the left lower lobe; intralobar sequestration drains to the pulmonary veins, and extralobar to systemic veins. CTA shows the feeding artery. Oesophageal atresia: a nasogastric tube that coils in the upper pouch; air in the stomach means a tracheal fistula below the atresia (the common type), and no air in the abdomen — atresia without a distal fistula; look for VACTERL anomalies. Polyhydramnios in pregnancy may hint at the anomaly.

The child: a large thymus and a "sail" are normal in an infant. "Round pneumonia" — a round opacity in a child under 8, usually pneumococcal, and not a tumour; repeat the film after treatment. An inhaled foreign body — mostly radiolucent; the sign is air trapping: a lung that stays lucent in expiration or when lying on the affected side; a normal film does not exclude it, and the treatment is bronchoscopy. Recurrent pneumonia in the same lobe — look for CPAM, sequestration or a foreign body. Cystic fibrosis: upper-lobe bronchiectasis, mucus plugs and hyperinflation. Empyema in a child — US to assess septations and drainage. Posterior rib fractures in an infant — specific for abuse. In every examination of a child — a size-adapted protocol and the lowest possible dose (Image Gently).

Key points

• RDS — preterm, low volume, granular.
• TTN — term, fluid in fissures, resolves.
• Oesophageal atresia — air in the abdomen = distal fistula.
• Foreign body — air trapping.
• Round pneumonia — under age 8.

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Sources

• Image Gently Alliance: Pediatric radiation safety recommendations, 2023 — Child-sized protocols
• ACR Appropriateness Criteria: Pneumonia in the Immunocompetent Child, 2019 — Chest radiography and US
• ACR–SPR Practice Parameter for the Performance of Chest Radiography (paediatric section), 2022 — Neonatal technique

Sources are given for further reading; the text is written afresh and not copied from them.

Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.