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Four stages of radiographic changes of BPD have been Excessive intra-airway pressure may lead to leak from the
described: stage I, which is RDS seen in the first week; stage alveolar ducts (primordial acini) into the lung interstitium.
II, which includes generalized haziness and plethora in the Once in the interstitium, the gas is picked up in the rich
second week; stage III, which involves cystic changes and lymphatic network of the neonate and carried toward the
stranding in the third week; and stage IV, which is pleural lymphatics and central bronchopleural lymphatics. PIE
characterized by hyperinflation, extensive stranding, and an usually occurs early during ventilation, and most infants
enlarged heart in the fourth week. present in the first 72 hours with this abnormality.
Pathophysiology: Passage of meconium into amniotic fluid Background: Epiglottitis is the inflammation of the supraglottic
most often represents a normal maturational event. However, in structures. In most cases, the condition is caused by a rapidly
many instances, it may occur in response to fetal hypoxia or developing bacterial infection of the epiglottis, which has the
acidosis. Meconium passage likely requires neural stimulation potential to cause abrupt airway obstruction.
of a mature gastrointestinal tract, without which there is no
peristalsis and relaxation of the rectal sphincter. This may Traditionally, this infection was most commonly caused by
explain why meconium is rarely found in the amniotic fluid Haemophilus influenzae type b (HIB), though Streptococcus
before 34 weeks' gestation. Meconium aspiration syndrome pneumoniae, Staphylococcus aureus, and group A beta-
chiefly affects infants at term and afterward. The amniotic fluid hemolytic streptococci were occasionally found.
and meconium mix to form a greenish-black fluid of variable
thickness, or viscosity. Sex: Epiglottitis is more common in males than females, with a
male-to-female ratio of about 3:1.
Meconium aspiration syndrome occurs when the newborn
aspirates the meconium-containing amniotic fluid. In addition Age: Before widespread use of the HIB vaccine, epiglottitis
to obstruction of the airway, the aspiration leads to an occurred mainly in young children, peaking between 2 and 7
inflammatory response in the lung parenchyma (chemical years of age. The disease is now rarely seen among children.
pneumonitis). It is this inflammation, not the meconium itself,
that results in the patchy infiltrates seen on chest radiography.
RADIOGRAPH is rare in the first 6 months of life. Stridor presenting in the first
6 months of life should initiate a search for other causes of
Findings: On plain radiographs, the normal epiglottis is a thin, stridor. Congenital anomalies and subglottic hemangiomas are
curved, flap of soft tissue opacity that is separated from the other conditions to consider that narrow the airway and cause
base of the tongue by air in the valleculae stridor in infants. The youngest reported child with croup was
aged 3 months.
In epiglottitis, images show diffuse soft-tissue swelling with
enlargement of the epiglottis and also of the normally thin RADIOGRAPH
aryepiglottic folds. One should look for an enlarged epiglottis
(thumbprint sign), thickened aryepiglottic folds, and ballooning • Frontal neck radiograph: The lateral walls of the
of the hypopharynx, usually with normal subglottic structures, subglottic larynx normally are convex or shouldered.
although a rare case of supraglottitis may cause infraglottic Wall edema in croup narrows this space with loss of
swelling lateral convexity, creating a steeple shape below the
vocal cords. The narrowing may extend for 5-10 mm
Croup below the vocal cords.
• Lateral neck radiograph: The hypopharynx is
Background: Croup is a generic term encompassing a overdistended during inspiration, and the subglottic
heterogeneous group of relatively acute conditions (mostly region is hazy as a result of narrowing of the airway by
infectious) characterized by a syndrome of distinctive brassy mucosal edema. The larynx airway is indistinct. The
coughs. These may be accompanied by inspiratory stridor, undersurface of the vocal cords normally identified
hoarseness, and signs of respiratory distress resulting from during phonation is not well identified. The epiglottis,
laryngeal obstruction. The word croup derives from an old aryepiglottic folds, and prevertebral spaces appear
Scottish term roup, which means "to cry out in a shrill voice." normal.