Presentation
Term delivery at 39 weeks gestation with severe fetal distress and meconium-stained fluid at birth. There is also meconium-stained skin on history.
Patient Data
A portable X-ray is performed immediately after birth.
Hyperinflated lung fields. A normal, but ill-defined cardiomediastinal contour. The NG tube is satisfactorily sited.
Bilateral, asymmetric, diffuse, patchy pulmonary opacities are in keeping with severe meconium aspiration pneumonitis. There is early confluent parenchymal shadowing with the right upper lobe, anterior segment. There are no pleural effusions, no hemo or pneumothorax and no pneumomediastinum.
Case Discussion
A term delivery at 39 weeks of gestation, with a reported history of meconium-stained fluid and meconium-stained skin.
The diffuse nature of the meconium aspiration on chest X-ray easily explains the severe fetal distress at birth.
Supra-added congenital pneumonia is difficult to exclude in this instance.
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