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Imaging in the pediatric population is unique, and it is essential for physicians to limit patient exposure to ionizing radiation in the medical workup due to increased risk of cancer development. Children are at higher risk of cancer development because they are more radiosensitive and live more years than adults. The use of nonionizing radiation in children with ultrasound and MRI is recommended when possible. Also, as demonstrated in the case presentations in this chapter, the initial imaging modalities of choice in the evaluation of the majority of pediatric patients include radiographs, which have a low amount of ionizing radiation, and ultrasound. Therefore, it is important to be aware of the imaging modalities and techniques available to promote radiation protection in the imaging of children and to take a conscientious approach to imaging this population.



Premature infant born at 28 weeks of gestation develops shortness of breath shortly after birth.


Surfactant deficiency disease


Chest radiograph


Surfactant deficiency disease, also called respiratory distress syndrome or hyaline membrane disease, is primarily seen in premature infants. It is a lung disease that occurs as a result of surfactant deficiency, resulting in alveolar collapse and decreased pulmonary compliance.

On frontal chest radiograph, there are low lung volumes associated with diffuse haziness or fine reticular granular opacities due to generalized alveolar collapse (Fig. C1.1). Prominent air bronchograms are seen due to patent larger bronchi in the diseased lung. Pleural effusions are an uncommon finding with surfactant deficiency disease.

Fig. C1.1

A 32-week-old premature infant with low lung volumes, diffuse hazy pulmonary opacities, and prominent air bronchograms, consistent with surfactant deficiency disease.

Treatment with surfactant replacement therapy can lead to clearing of the granular opacities and increased lung volumes. In some cases, there may be asymmetric clearing of lung opacities indicating partial response to treatment. In addition to surfactant replacement therapy, neonates with surfactant deficiency commonly require mechanical ventilation for treatment and respiratory support.

During this time, chest radiograph may show coarse granular opacities and mixed areas of overinflation and atelectasis before returning to normal appearance. Appearance on the chest radiograph may mimic meconium aspiration leading to misdiagnosis if not clinically correlated. Mechanical ventilation can also be associated with several potential complications, including pulmonary interstitial emphysema and air-block complications such as pneumomediastinum, pneumothorax (Fig. C1.2), and pneumopericardium.

Fig. C1.2

Frontal radiograph of the chest shows a preterm infant with surfactant deficiency disease and a left-sided ...

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