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Figure 7.64. This infant developed increasing respiratory distress. Radiography of die chest showed abnormal placement of the feeding tube that tracks into the right thorax. Associated with this are increased infiltrates, most prominent in the right lung. The abnormal placement of the feeding tube occurred as a result of esophageal perforation.

Figure 7.66. Abdominal radiograph of an infant widi pneumoperitoneum as a result of nasogastric tube perforation of the stomach. Note the midline lucency, the "football sign," with visible falciform ligament. Perforation of die stomach may occur spontaneously as a result of a weakness in die wall of the stomach. It is also reported from placement of feeding catheters. Application of suction, especially if the catheter tip is up against the stomach wall, can cause damage. (Singleton, E.)

Figure 7.65. Radiograph of the chest of the same infant 24 hours later showing a right-sided pneumothorax and placement of the nasogastric feeding tube in the left thorax as the result of esophageal perforation. It should be noted that the feeding tube may pass either to the right or left side of the chest. Spontaneous perforation of the esophagus (Boerhaave's syndrome) does occur, but would be extremely rare in a neonate. Neonatal perforation is usually associated with trauma such as from a feeding tube.

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Figure 7.67. Soft tissue swelling of the neck was crepitant to palpation. This infant developed subcutaneous emphysema as a result of resuscitation. The subcutaneous emphysema absorbs spontaneously.

Figure 7.68. Radiograph of the chest and abdomen in an infant showing massive left pneumothorax and pneumomediastinum with displacement of the heart to the right side. On the right side some air is noted between the diaphragm and the upper border of the liver. This is a mild pneumoperitoneum from tracking down of air from the pneumomediastinum. This iatro-genic pathology occurred with vigorous bag and mask resuscitation using excessive pressures.

Figure 7.69. Radiograph of the chest in an infant requiring resuscitation at delivery. Note the pneumo-mediastinum with the lobes of the thymus gland being very prominent bilaterally ("butterfly wing" appearance) as a result of the air in the pneumomediastinum lifting up the lobes of the thymus.

Figure 7.70. Radiograph of the chest in an infant with severe respiratory distress who developed a pneumo-pericardium causing cardiovascular instability.

Figure 7.71. Chest and abdominal radiograph in an infant with massive air leak. Note the pneumothorax, pneumomediastinum, pneumoperitoneum and subcutaneous emphysema. This problem occurred as a result of the use of excessive pressures in ventilating the infant.

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