vrpatilisl Posted May 15, 2020 Share Posted May 15, 2020 hi all, I had baby 36 weeks completed gestation, on admission severe respirstory distress,given surfactan , distress not setteled after 24hrs of ventilation (invasiveSIMV ). Xray still shwing complete white out, repaeat surfactant given still no improvent CT chest done its normal. Sepsis screen negative. what could be reason for complete white out and not improving lung fields? thanking you. 1 Link to comment Share on other sites More sharing options...
bimalc Posted May 15, 2020 Share Posted May 15, 2020 Are you able to elaborate on the chest CT and/or share images? I find it quite hard to fathom how a CXR showed total white out at the same time that a chest CT was completely normal. Also, more clinical information would be helpful: blood gases, response to surfactant, vent settings, etc. Link to comment Share on other sites More sharing options...
HickOnACrick Posted May 15, 2020 Share Posted May 15, 2020 Was there a transient improvement in SaO2 and FiO2 after surfactant administration, say for 2-4 hours? If so, I would consider a surfactant protein mutation such as heterogenous SPB mutation or homogenous/heterogenous ABCA3 mutation. Also SPC mutations are highly variable in their presentation(s). Homogenous SPB mutations may have a brief response to surfactant, but will inevitably return to a severe RDS clinical picture. Heterogeneous SPB mutations may be survivable if the baby is full term. Heterogeneous ABCA3 mutations are survivable if not premature while homogenous ABCA3 mutations are often fatal, even in full-term babies. Recommend searching papers by N. Nogee and A. Hamvas Another thought, the penetration of the Xrays may not have been optimized for the type of CXR; thus the CXR looks abnormal while the CT is normal. Does the "whiteness" of the stomach bubble correspond to the "whiteness" of the lung? if so, the CXR was probably under penetrated. if the stomach bubble is much blacker than the lung fields, there is a problem with the lungs. 1 Link to comment Share on other sites More sharing options...
Aedi Budi Dharma Posted May 16, 2020 Share Posted May 16, 2020 Chest ultrasound might help, since air-fluid interface give a different artifact compare with full filled fluid 1 Link to comment Share on other sites More sharing options...
abomran Posted May 17, 2020 Share Posted May 17, 2020 How about doing an echocardiogram to rule out total anomalous pulmonary venous return? 2 Link to comment Share on other sites More sharing options...
bimalc Posted May 19, 2020 Share Posted May 19, 2020 On 5/15/2020 at 3:43 PM, HickOnACrick said: homogenous/heterogenous Homozygous/heterozygous? 1 Link to comment Share on other sites More sharing options...
HickOnACrick Posted May 22, 2020 Share Posted May 22, 2020 On 5/19/2020 at 8:50 AM, bimalc said: Homozygous/heterozygous? Yes, you are correct Link to comment Share on other sites More sharing options...
Dr.Smah Posted May 23, 2020 Share Posted May 23, 2020 I think pulmonary hemorrhage should be excluded also 1 Link to comment Share on other sites More sharing options...
Bernhard Bungert Posted May 28, 2020 Share Posted May 28, 2020 Remembers me to case of Surfactant protein Mutation. Done well After Ltx At age of 7 month. But me need more information: what Kind of Ventilation you use. Which Setting? Oscillation? NO? Echo Shows pulmonary hypertension? Please look for CMV in tracheal aspirat. Link to comment Share on other sites More sharing options...
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