Neonatal Respiratory Distress and Congenital Chest Anomalies — WACS Viva & Clinical Scenarios (Paediatric Radiology)

Exam-style neonatal respiratory distress and congenital chest anomalies viva scenarios with examiner probes and model answers for Radiology candidates.

Scenarios covered

• SCENARIO 1: A 30-minute-old preterm male neonate born at 28 weeks of gestation presents with severe tachypnoea, grunting, and intercostal retractions. Describe the characteristic plain chest radiographic findings of neonatal respiratory distress syndrome (surfactant deficiency), state the key radiographic staging criteria, and list three imaging features that differentiate it from transient tachypnoea of the newborn.
• SCENARIO 2: An emergency mobile chest radiograph of a term infant with acute respiratory failure shows multiple round, air-filled cystic structures within the left hemithorax, mediastinal shift to the right, and a relative paucity of abdominal gas. Detail the primary radiological diagnosis, essential differential diagnoses, and the critical plain film sign that distinguishes a congenital diaphragmatic hernia from congenital pulmonary airway malformation (CPAM) Type I.
• SCENARIO 3: A term infant born via emergency caesarean section for meconium-stained liquor requires positive pressure ventilation and suddenly develops acute cardiovascular collapse and oxygen desaturation. Outline the emergency plain radiographic approach to identify acute tension air-leak syndromes (pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema) and describe the radiological indicators of tension physiology in the neonate.
• SCENARIO 4: Explain the imaging evaluation of congenital bronchopulmonary malformations, detailing the specific contrast-enhanced computed tomography (CT) and Doppler ultrasound criteria used to differentiate an extralobar pulmonary sequestration from an intralobar sequestration, congenital lobar overinflation (emphysema), and bronchogenic cyst.
• SCENARIO 5: In the neonatal intensive care unit (NICU), radiologic verification of vascular catheters and endotracheal tubes is paramount. Specify the precise anatomical landmarks and vertebral levels indicating the ideal radiological tip positions for an endotracheal tube, an umbilical venous catheter (UVC), and high versus low umbilical arterial catheters (UAC), along with two common radiographic complications of malposition for each.