The Utility of Special Radiological Signs on Routinely Obtained Supine Anteroposterior Chest Radiographs for the Early Recognition of Neonatal Pneumothorax

Background: Bedside chest radiographs used for the confirmation of diagnosis of pneumothorax in the neonatal intensive care unit (NICU) are routinely obtained in the supine position. However, pneumothoraces may not appear in the classically described forms on these radiographs, resulting in a delayed diagnosis. Objective: To assess the utility of special radiological signs in the neonatal population for the early recognition of pneumothorax. Methods: A case-control study was conducted at a level III referral center from January 2006 to December 2012. For each neonate with pneumothorax, one infant was selected for the control group. A senior radiologist and neonatologist experienced in reading chest radiographs evaluated each radiograph for the presence of special radiological signs. Results: Of the 1,375 infants admitted to the NICU during the study period, 39 had a pneumothorax. A total of 223 radiographs were scored and 46% of the neonates were found to have occult pneumothoraces before they were clinically diagnosed. Twenty-six percent had a single sign detected on a radiograph, whereas 20% had multiple signs. The time interval between the appearance of these signs and clinical diagnosis ranged between 0.5 and 27 h. Conclusions: The present study shows that the recognition of these signs would assist the physician in identifying occult pneumothorax earlier in its course. Physicians dealing with critically ill infants should ensure that they can recognize these radiological signs.