White dots on a black background or black dots on a white background – cystic or alveolar pattern? This child is 1 month old and has a history of prematurity.
What are you thinking?

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Answer:

BPD

Features:

 

 

area of hyperexpansion and atelectasis interspersed with patchy areas of fibrosis.

 

Cause:  

 

chronic PPV

 

DDX Diffuse Patchly alveolar ASD Neonate:

 

“White Dots on a Black Background”
High lung volume – TTN, meconium aspiration(both term)
Low lung volume – HMD(preterm)
Variable lung volume – pneumonia, CHF/PDA(term or preterm)

 

DDX Diiffuse Cystic Lung Disease in Neonate:

 

"Black Dots on a White Background”
Week 1 – PIE
Week 2-3 – Wilson-Mikity
Week4 – BPD, Wilson Mikity

 

 

Mikity – Wilson Syndrome:

  • Identical radiographic pattern to BPD in normal preterm infants breathing room air.
  • These Kids look like they have BPD, but the clinical course does not match – it may be seen at < 4weeks, they did not require chronic PPV, and/or they were’nt born with HMD.
  • Thought to result from perinatal pneumonia.
  • Gradual onset of respiratory distress 10-14d after birth.
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