title: The utility of special radiological signs on routinely obtained supine anteroposterior chest radiographs for the early recognition of neonatal pneumothorax.
abstract: BACKGROUND
  Bedside chest radiographs used for the confirmation of diagnosis of pneumothorax in the neonatal intensive care unit (NICU) are routinely obtained in the supine position. However, pneumothoraces may not appear in the classically described forms on these radiographs, resulting in a delayed diagnosis.
  
  
  OBJECTIVE
  To assess the utility of special radiological signs in the neonatal population for the early recognition of pneumothorax.
  
  
  METHODS
  A case-control study was conducted at a level III referral center from January 2006 to December 2012. For each neonate with pneumothorax, one infant was selected for the control group. A senior radiologist and neonatologist experienced in reading chest radiographs evaluated each radiograph for the presence of special radiological signs.
  
  
  RESULTS
  Of the 1,375 infants admitted to the NICU during the study period, 39 had a pneumothorax. A total of 223 radiographs were scored and 46% of the neonates were found to have occult pneumothoraces before they were clinically diagnosed. Twenty-six percent had a single sign detected on a radiograph, whereas 20% had multiple signs. The time interval between the appearance of these signs and clinical diagnosis ranged between 0.5 and 27 h.
  
  
  CONCLUSIONS
  The present study shows that the recognition of these signs would assist the physician in identifying occult pneumothorax earlier in its course. Physicians dealing with critically ill infants should ensure that they can recognize these radiological signs.
authors.affiliation: Division of Neonatology, Department of Pediatrics, Fatih University Medical School, Ankara, Turkey.
authors.forename: Mehmet Nevzat
authors.initials: MN
authors.lastname: Cizmeci
authors.forename: Kayihan
authors.initials: K
authors.lastname: Akin
authors.forename: Mehmet Kenan
authors.initials: MK
authors.lastname: Kanburoglu
authors.forename: Ahmet Zulfikar
authors.initials: AZ
authors.lastname: Akelma
authors.forename: Hilal
authors.initials: H
authors.lastname: Andan
authors.forename: Onur
authors.initials: O
authors.lastname: Erbukucu
authors.forename: Mustafa Mansur
authors.initials: MM
authors.lastname: Tatli
mesh_terms: D016022:Case-Control Studies; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D008297:Male; D011030:Pneumothorax / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D019095:Point-of-Care Systems; D011237:Predictive Value of Tests; D013902:Radiography, Thoracic / Q000379:methods*; D012189:Retrospective Studies; D016683:Supine Position