Congenital defects of diaphragm or malformations of lung usually present in first few hours of birth and if left undiagnosed can lead to significant morbidity and mortality. Early accurate recognition is paramount for subsequent management.
Aim To highlight cases presenting to tertiary neonatal unit with respiratory distress on admission and similar chest x-ray changes.
Case 1 Term infant, one of dichorionic diamniotic twins with antenatal history of polyhydramnios admitted with respiratory distress soon after birth. Initial Chest X-ray (CXR) showing homogeneous opacification of left hemithorax with mediastinal shift to right. Subsequent CT chest revealed Bronchogenic cyst.
Case 2 Term infant admitted with respiratory distress. Initial CXR showed homogeneous opacification of left hemithorax with mediastinal shift to right. Subsequent CXR revealed left sided diaphragmatic hernia.
Case 3 Premature infant born at 34 weeks of gestation with multiple congenital anomalies. Initial CXR showed almost complete opacification of right hemithorax. Chest ultrasound was suggestive of severe right sided diaphragmatic eventration.
Conclusion Chest X-ray is a readily available and commonly performed initial radiological investigation in newborns. Although it can detect most common conditions presenting in newborns, it is important to recognize its limitations and consider further imaging as highlighted in our case series.
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