Susana Correia de Oliveira1, Joana Mendes2, Jorge Correia Pinto3, Andreia A. Martins4
1Department of Pediatrics, Senhora da Oliveira Hospital, Guimarães, Portugal, 2Department of Pediatrics, University Hospital Center of Cova da Beira, Covilhã, Portugal, 3Department of Pediatric Surgery, Braga Hospital, Braga, Portugal, 4Department of Neonatology, Senhora da Oliveira Hospital, Guimarães, Portugal
Address for Correspondence: Susana Correia de Oliveira, Department of Pediatrics, Senhora da Oliveira Hospital, Rua dos Cutileiros, nº114, Creixomil, 4835-044.
Email: susanafco@hotmail.com
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Question :A male term newborn was born from a monitored and uneventful 38 weeks gestation via an elective caesarean section with Apgar scores of 8/8/8 at first, fifth and tenth minutes respectively and with a birth weight of 2980 g. Two minutes after birth he began to have irregular respiratory movements and started intermittent positive pressure ventilation followed by alveolar recruitment. Since he maintained signs of respiratory distress he was admitted to a neonatal intensive care unit (NICU) and was put on continuous positive airway pressure (CPAP) of 4,5 cm H2O and fraction of inspired oxygen of 0,30. Laboratory markers for infection were negative and arterial blood gas excluded respiratory or metabolic acidosis. Two hours after admission in the NICU, the newborn showed signs of clinical improvement and suspended CPAP, beginning spontaneous breathing with no need of supplemental oxygen and with arterial oxygen saturation above 94%. An anterior-posterior chest-radiography (CXR) at six hours of life revealed a hyperlucency around the left cardiac border and wedge-shaped opacities of the upper third of the right hemithorax and of the two upper thirds of the left hemithorax (Figure 1). For better understanding of this image, a low-radiation axial computed tomography (CT-scan) of the chest was performed revealing a normal airway and pulmonary parenchyma and a centered mediastinum showing evidence of a small amount of air. Pulmonary congenital malformations or other masses were excluded. Since the newborn remained haemodynamically stable, the clinicians opted for a conservative approach. There was a favorable clinical evolution and he was discharged at four days of age, asymptomatic and with radiological improvement. Follow-up after four weeks revealed a full radiographic resolution.
Figure 1. Hyperlucency around the left cardiac border and wedge-shaped opacities of the upper third of the right hemithorax and of the two upper thirds of the left hemithorax, raising suspicion of a pneumomediastinum.  What is the diagnosis?
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