Friday, June 30, 2017

Meconium Aspiration Syndrome - X ray Chest

This X ray is of a one day old baby who had difficulty breathing.

X-ray chest shows right upper lobe consolidation and rest of the lungs show patchy to streaky areas suggesting meconium aspiration syndrome

Explanation: In meconium aspiration syndrome (MAS) the newborn breathes a mixture of meconium and amniotic fluid into the lungs around the time of delivery.
Meconium is the early feces passed by a newborn soon after birth, in some cases; the baby passes meconium while still inside the uterus. This usually happens due to lack of enough blood and oxygen.
Once the meconium has passed into the amniotic fluid, the baby may breathe meconium into the lungs. This condition is called MAS. It causes breathing difficulty due to inflammation in the lungs after birth.
Meconium aspiration syndrome is a leading cause of severe illness and death in newborns. However, in most cases, the outlook is excellent and there are no long-term health effects provided the infant is placed in newborn intensive care unit for close observation and treatment

Clinical Discussion: babies who suffer hypoxic stress in utero may pass meconium, from their gastrointestinal tract, into the amniotic fluid which is then inhaled.
Meconium consists of hyperosmolar, viscid intestinal secretions. Aspiration of small amounts may be harmless; inhalation of large amounts results in widespread patchy collapse and consolidation combined with a severe inflammatory reaction. The viscous inhaled meconium may cause complete
bronchial obstruction or partial occlusion with a ‘ball valve’ effect that may lead to areas of hyperinflation in the peripheral lung.

The chest radiograph shows patchy areas of collapse and consolidation with areas
of hyperinflation or in severe cases almost a white out due to alveolar consolidation.

Pneumothorax and pneumomediastinum are frequent complications which can result in hypoxia and lead to pulmonary artery vasoconstriction, pulmonary hypertension and right-to-left shunting across
the ductus arteriosus.

The treatment is immediate removal of the meconium by suction of the airways via an endotracheal tube at the time of delivery. If this is not possible management is often difficult and recovery is often slow. Occasionally, treatment with extracorporeal membrane oxygenation is required.

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