Radiological Case of the Month FREE

A 2900-G, FULL-TERM MALE was born to a 24-year-old primiparous woman. Apgar scores were 8 and 8 at 1 and 5 minutes, respectively. At 24 hours of life, he had a grade III/VI systolic murmur at the lower left sternal border and developed circumoral cyanosis. His respiratory rate was 70 beats per minute; oxygen saturation, 70% to 85%. Arterial blood gas showed a pH of 7.45; PCO₂, 24; PO₂, 35; and base deficit, 5.6. After oxygen therapy was started with a fraction of inspired oxygen (FIO₂) of 1.0, arterial blood gas levels were pH, 7.41; PCO₂, 34; and PO₂, 44. Blood samples were obtained, and ampicillin sodium and gentamicin sulfate were administered. His weight was 2810 g; height, 49 cm; and head circumference, 34.6 cm. Vital signs included a heart rate of 148 beats per minute; respirations, 44 per minute; and blood pressure, 66/31 mm Hg. A holosystolic murmur was heard at the lower left sternal border. An echocardiogram revealed normal cardiac structure and evidence of increased right ventricular pressure with persistent right to left shunting at the foramen ovale and ductus arteriosus.

Diagnosis was primary pulmonary hypertension (PH) in the newborn. Umbilical venous and arterial lines were placed. Chest radiography demonstrated pulmonary vascular congestion. Abdominal radiography was performed following placement of the umbilical venous catheter (Figure 1). The infant maintained an adequate PCO₂ level, but required an oxygen hood with FIO₂ of 0.85 to maintain saturation greater than 90%. He did not improve over the next 12 days, and his oxygen requirement was unchanged. His trachea was intubated, and he was ventilated with FIO₂ of 1.0 to decrease PH. On day 14, an echocardiogram and cardiac catheterization were performed (Figure 2).