Term Neonate with Respiratory Distress.

Abstract

A female infant is born at 39 weeks to a 21-year-old primigravida with an unremarkable antenatal history and good prenatal care. The Apgar scores are 6, 7, and 8 at 1, 5, and 10 minutes, respectively. Physical examination reveals an appropriate-for–gestational age 3.3-kg term infant with grunting, tachypnea, and intercostal retractions. Decreased air entry is noted over the right side of the chest. A grade 2/6 systolic murmur is heard over the left sternal border with normal heart sounds and good peripheral pulses. The rest of the physical examination findings are within normal limits except for a right-sided small ear tag. The neonate requires positive pressure ventilation initially in the delivery room and then is placed on continuous positive airway pressure (CPAP) at 30% fraction of inspired oxygen. Chest radiography shows near-complete opacification of the right thorax with mass effect and normal lung markings on the left (Fig 1). Due to worsening respiratory distress, she undergoes intubation and is transferred to the regional perinatal center for diagnosis and management. Figure 1. Anteroposterior view radiograph of chest and abdomen at birth showing near-complete opacification of the right thorax. Differential diagnoses considered at this point for unilateral lung field opacity with mass effect include right-sided diaphragmatic hernia, congenital pulmonary airway malformation, pulmonary sequestration, or a space-occupying lesion like a tumor. Ultrasonography of the chest shows a large, solid mass in the right thorax with an intact diaphragm, an abnormality consistent with consolidated lung or a tumor (Fig 2 …