Which of the following is the MOST accurate criterion for defining respiratory distress syndrome (RDS/HMD) in a preterm neonate on chest X-ray?

• A Unilateral homogeneous opacification with mediastinal shift
• B Streaky hilar shadowing with fluid in horizontal fissure
• C Bilateral reticulo-granular (ground-glass) opacification with air bronchograms ✓
• D Hyperinflation with flattened diaphragm

Explanation

RDS (hyaline membrane disease) is characterized on CXR by bilateral diffuse reticulo-granular (ground-glass) opacification with prominent air bronchograms, which represents atelectatic alveoli against patent airways. Mediastinal shift suggests tension pneumothorax or pleural effusion. Fluid in the horizontal fissure is characteristic of transient tachypnea of the newborn (TTN). Hyperinflation with flattened diaphragm is seen in meconium aspiration syndrome or air trapping states.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.