36 Adhesive Atelectasis

Clinical Presentation

1,260 g girl born at 30 weeks’ gestation presenting with retractions, grunting, and poor air movement and requiring oxygen; has received one dose of surfactant, with some clinical improvement

Radiologic Findings

AP chest radiograph (Fig. 36.1) shows bilateral, symmetrical, perihilar opacities with a fine granular pattern and associated air bronchograms. The lung volumes are diminished bilaterally. Note the endotracheal tube, enteric tube, umbilical arterial and umbilical venous catheters.

Diagnosis

Adhesive Atelectasis: Respiratory Distress Syndrome (RDS) of the Newborn

Differential Diagnosis

• Pneumonia

• Volume overload or heart failure

• Massive aspiration

• Pulmonary hemorrhage

Discussion

Background

The pressure-volume relationships of the lung depend on forces acting at the air-tissue interface of the alveolar wall. These forces are further understood by applying Laplace’s law (p = 2T/r), where p represents pressure, T the surface tension at the air-tissue interface, and r

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