streaky perihilar opacities newborn streaky perihilar opacities newborn

( c, d) The prominent thymus mimics a . ECMO has improved the survival of some patients by circumventing the problem of pulmonary hypertension and the right-to-left shunting of blood away from the lungs. Pneumonias may have more recent onset with cough, fever, and breathlessness while cancer is a more long standing progressive process. Also, prostaglandins dilate pulmonary lymphatics to absorb excess fluid. US may be particularly helpful in assessing a catheters position and injection of very small amounts of intravenous water-soluble, low osmolar contrast medium may also be useful in checking the position of the tip. 76-2), due to collapsed alveoli interspersed with distended bronchioles and alveolar ducts. Nasogastric tube tip positions should always be reported on, in order to avoid misplacement of nasogastric feeds. Other imaging findings and the clinical history can help us narrow the diagnosis. Please read the disclaimer The mediastinum is the compartment of the chest between the lungs. These are plastic clips used to clamp the umbilicus before it is cut at birth. Research shows that colloidal oatmeal reduces inflammation and itching, which may prevent the baby from scratching any damaged, peeling skin and making it worse. This is an infiltrate that is seen only on one side around the hilum. (B) Repeat radiograph after 3 weeks reveals diffuse haziness in bilateral lung fields The autopsy findings state edema and pulmonary hemorrhage rather than atelectasis as the primary pathology. There is mediastinal widening, due to normal thymic tissue. Additionally, pure ground-glass opacity nodules took longer to double in size than ground-glass opacity nodules with solid masses in these studies. You can learn more about how we ensure our content is accurate and current by reading our. These descriptions means the same thing. Cold air is often quite dry and can cause the skin to dry out in turn. Pulmonary opacities in children are classified in the same way as in adults: as primarily alveolar or interstitial, focal or diffuse, and unilateral or bilateral. Mixed patterns also occur. The tachypnea usually resolves within 48 hours. This entity seems inseparable from the condition described previously as WilsonMikity syndrome. It is most common in infants who are post-mature. RSV and pneumonia are related in that RSV can cause pneumonia. This results in hyperinflation (due to air trapping as a result of partial bronchial obstruction as a result of peribronchial thickening), segmental and subsegmental atelectasis and small patches of consolidation frequently occurring in a perihilar location (Fig. Their skin is more sensitive than adult skin and has not yet adapted to the environment outside the, Many people have dry skin. Normally fluid is cleared from the lungs at, or shortly after, birth by the pulmonary lymphatics and capillaries. ncbi.nlm.nih.gov/pmc/articles/PMC7935089/, sciencedirect.com/science/article/abs/pii/S036301881400005X?via%3Dihub, ncbi.nlm.nih.gov/pmc/articles/PMC6909955/, ncbi.nlm.nih.gov/pmc/articles/PMC7434019/, nhlbi.nih.gov/news/2020/medical-imaging-advances-may-reduce-radiation-risk-vulnerable-patients, ncbi.nlm.nih.gov/pmc/articles/PMC7350036/. The process resolves rapidly with almost complete resolution in 48 hours. A lung PET scan is used to take. Pneumonia can commonly have this appearance. (2016, September 16). There is bilateral asymmetrical coarse pulmonary opacification and small bilateral pleural effusions (arrows). Newborn babies often have dry, peeling skin. The tip of the umbilical venous catheter is in the IVC (short arrow) and should ideally be placed more distally in the IVC close to the right atrium. At the time the article was created Rishi Agrawal had no recorded disclosures. Limiting a baby's exposure to cold air . It may involute rapidly with prenatal or postnatal stress, for example in severe illnesses such as hyaline membrane disease or infections, or following corticosteroid treatment. The appearances are similar to those seen in meconium aspiration syndrome. Due to this, their skin does not exfoliate as adults skin does. As newborn chest radiographs are taken in the AP plane, the normal cardiothoracic ratio can be as large as 60%. While symptoms may be similar, other viruses can cause a cold as well. Radiograph obtained immediately following insertion of a veno-venous catheter in the right atrium (arrow). Interstitial lung disease that predominates in the lower lobes can be seen with tuberous sclerosis, connective tissue diseases, and primary interstitial pneumonitis. Some abnormalities occur in a central or parahilar distribution, whereas others are predominantly peripheral or basal in location. Some infants are delivered by cesarean section; some without labor. Bilateral ill-defined perihilar, peribronchial opacities are the result of a viral bronchitis, accompanied by focal streaky opacity in the right lower lobe. Transient tachypnea of the newborn. {"url":"/signup-modal-props.json?lang=us"}, Jones J, Bickle I, Bell D, et al. We avoid using tertiary references. Ground-glass opacity can also indicate an infection or other inflammatory process, which is usually what a clinician will share with you or your loved one who has had a CT scan or X-ray. Limiting the amount of time in the bathtub. (A) The childs trachea is buckled and the heart appears enlarged; both phenomena are not shown on a subsequent radiograph (B) taken in good inspiration. Inherited mutations in the SpB and ABCA3 are autosomal recessive and may present immediately after birth with respiratory symptoms. Prenatal corticosteroid administration during the 2 days prior to delivery significantly reduces the incidence of IRDS in premature infants. Most likely they represent intense interstitial disease compressing the alveoli. 76-5). Infection with common viral, bacterial, and fungal organisms creates a pattern similar to that seen in immunocompetent children, but the findings tend to be more rapidly progressive and more pronounced. First of all, have a look to see if the neonate is premature or not - signs of prematurity being reduction in subcutaneous fat and the lack of humeral head ossification (the latter occurs around term). Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-2198, {"containerId":"expandableQuestionsContainer","displayRelatedArticles":true,"displayNextQuestion":true,"displaySkipQuestion":true,"articleId":2198,"questionManager":null,"mcqUrl":"https://radiopaedia.org/articles/transient-tachypnoea-of-the-newborn/questions/1108?lang=us"}. Compression of the ipsilateral lung in utero causes it to be hypoplastic, and often the contralateral lung is also small. Learn about the benefits, risks, and accuracy of low dose CT scans for lung cancer detection, as well as who should be screened for lung cancer, and, PET scan is an imaging technique that uses a radioactive tracer to locate tissue differences at a molecular level. A PA erect radiograph taken at full inspiration is optimal but difficult to obtain in uncooperative children; hence, an AP supine view is usually obtained in infants and small children. Ground-glass opacity is a radiological term that refers to hazy gray areas on the images made by CT scans or X-rays. 76-19) or in some institutions inferior to L3 vertebral bodies. 10 of the best lotions for dry skin of 2022. A higher incidence of BPD has been demonstrated in infants with previous culture-proven Ureaplasma urealyticum pneumonitis.3. MNT is the registered trade mark of Healthline Media. There is a pigtail drainage catheter in situ. Some pneumonias may require antibiotics while others need supportive care like viral pneumonias. they cannot be bronchi). Congenital diaphragmatic hernia may occasionally be minimally symptomatic at birth, presenting later in life. If it is not one of the big 3, then you need to look for other patterns (e.g. One thing that can show on a CT scan or X-ray is a degree of haziness referred to as opacity. The use of positive pressure ventilation in the newborn is the most common cause of pneumothorax, pneumomediastinum, pulmonary interstitial emphysema (Fig. Colloidal oatmeal formulations and the treatment of atopic dermatitis. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Complementary Medicine / Alternative Medicine, http://americanpregnancy.org/while-pregnant/second-trimester/, http://jddonline.com/articles/dermatology/S1545961614P1180X, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574071, https://kidshealth.org/en/parents/newborn-variations.html?ref=search&WT.ac=msh-p-dtop-en-search-clk, https://med.stanford.edu/newborns/professional-education/photo-gallery/skin.html#normal_peeling, https://www.sciencedirect.com/science/article/pii/S0738081X14003022?via%3Dihub, One-hour endoscopic procedure could eliminate the need for insulin for type 2 diabetes, New clues to slow aging? Cardiac failure as a primary cause of pleural effusion in children is not common. Normal Anatomy and Artefacts It can also be beneficial to apply moisturizer immediately after a lukewarm bath. A pneumomediastinum usually outlines the thymus (Fig. Reducing exposure to cold air. Sometimes it is temporary and the result of a short-term illness. The most common cause of atelectasis is surgery with anesthesia. A new type of BPD was described by Jobe in 19995 in immature infants with minimal lung disease at birth, and who become symptomatic during the first week of life. The tip of an ET tube may vary considerably with head and neck movement and the correct position must therefore be assessed by taking the patients head position and the tip of the tube into consideration. Although the hernia itself is most often unilateral, the increased volume of the thorax on the side of the hernia causes compression of the contralateral lung, resulting in bilateral and asymmetric lung hypoplasia (, Extrathoracic compression of the fetal lungs is most often caused by oligohydramnios secondary to fetal urinary tract abnormalities or by abnormal amniotic fluid production or leakage. Chapter Outline bronchial carcinoid. This reduced clearance of fluid from the lungs is why some have proposed that it is more commonly seen in cesarean section deliveries since the thoracic compression that would occur in a normal vaginal delivery does not take place. There is also an increased incidence in small, hypotonic and sedated infants who have had a precipitous delivery. Check for errors and try again. Very premature infants, less than 26 weeks gestation, may have clear lungs or mild pulmonary haziness initially. Pediatr Radiol. Chest radiographic findings may be present shortly after birth but occasionally the maximum features may not be present until 624 hours of life. Air Leaks 76-10). This prostaglandin imbalance is also worsened in other situations like maternal diabetes or asthma, and in male newborns. At the end of this phase primitive alveoli form. newborn. In the very premature infant, less than 27 weeks gestation, the lungs become clear following surfactant administration, but they are still immature with fewer alveoli than normal. They should take a baby to see the doctor if the skin is: If the baby is running a fever, medical attention will be necessary. Furthermore, 97.1% of African Americans were RT-PCR (+) compared to 65.8% of Caucasians. Chlamydial infection classically presents first with conjunctivitis at 12 weeks after birth and the lung infection does not usually become evident until 412 weeks of age. Bat wing opacities, also known as butterfly opacities, refer to a pattern of bilateral perihilar lung shadowing. However, it should not usually be cause for concern. opacification may also be a superimposed problem, and is usually due to severe hypoxia and capillary damage (. Lung opacities are common, 2021 research suggests. FIGURE 5.7. Viral pneumonia in kids can give this appearance. This may involve soothing them and helping them to find positions that avoid putting pressure on the peeling skin. There are multiple causes of perihilar infiltrates. Viral infection usually affects the respiratory mucosa and airways, causing bronchial and bronchiolar oedema. The overgrowth may be limited to a portion of the body, such as the legs, or it may involve several different areas of the body, including the arms, face (causing asymmetry of the nose, eyes or cheeks), tongue, jaw, teeth and . One cause of acute breathlessness in a neonatal patient is a mass within the hemithorax causing ipsilateral pulmonary hypoplasia/atelectasis and mediastinal shift. 76-16) and when there is a pneumopericardium the air surrounds the heart (Fig. An inspiratory plain chest radiograph is considered adequate when the right hemidiaphragm is at the level of the eighth rib posteriorly. Table 50.3 Causes of Parahilar Peribronchial Opacity, Table 50.4 Conditions Causing Hazy, Reticular, or Reticulonodular Patterns, Pulmonary edema, when it is confined to the interstitial space, often produces a hazy or reticular pattern in the lungs. (2014). The presence of pleural effusions, pulmonary hyperinflation and mild cardiomegaly may not be helpful in differentiating pneumonia from these other conditions. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-16903. The hole in the incubator top may be confused with a pneumatocele or lung cyst. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. What causes skin on the fingertips to peel? Within all age groups, viral infection is more common than bacterial. Other conditions, like alveolar hemorrhage and lung cancer, require more serious treatments. A similar process may occur with, Pneumonia caused by gram-negative bacilli is uncommon in children; it occurs primarily in infants and immunocompromised children. Table 50.3 Causes of Parahilar Peribronchial Opacity It should not be at or above the GEJ, but rather projected over the stomach, UAC (umbilical arterial catheter): it is the one that dips down into the pelvis and should have a tip above (T6-9) or below (L2-5) the renal arteries and unpaired aortic branches, UVC (umbilical venous catheter): it should enter at the level of the umbilicus and head north with its tip at the RA/IVC junction - not in the hepatic veins (right hand side) or portal vein (left hand side), peripheral line (PICC):from arm, leg or scalp (!). Such infections may result in pulmonary opacities that differ significantly from those seen with bacterial pneumonia. A, Hazy, reticular, or reticulonodular opacities, Congenital lobar hyperinflation or emphysema, Aberrant Left Pulmonary Artery (Pulmonary Sling). Group B streptococcus is the most common organism identified. 76-12). Streaky opacities scattered in both lung fields means that there might be small straight lung shadows along the air passages on your X-ray on both the sides. Hemihyperplasia, also called hemihypertrophy, refers to overgrowth of one side of the body in comparison with the other. Anything that causes the normal air filled dark lungs to lose this appearance and be whiter can be referred to as perihilar infiltrates. The normal lung development is well described by Agrons etal.1 During the embryonic phase of gestation (from 26 days to 6 weeks) the lung bud develops from the primitive foregut and divides to form the early tracheobronchial tree. Some increased increased opacity seen on the film, that can be from fluid (), infection, scar tissue, or just an over-zealous reading by the radiologist.Hyperinflation implies (but does not diagnose) airway obstruction, such as is seen in asthma, or emphysema or other similar disorders. Part of the treatment for the newborns peeling skin involves keeping the baby as comfortable as possible. A very ill newborn with a streaky pattern in both lungs and a large unilateral right pleural effusion. Radiograph shows mild hyperinflation, prominent vasculature, interstitial opacification most marked in the lower lobes and small pleural effusions (arrows) suggestive of TTN. The association of Ureaplasma urealyticum with neonatal pneumonia is increasingly recognised. However, parents and caregivers should look for additional signs and symptoms. 76-3). A newborns skin is very sensitive. A, Congenital Lobar Hyperinflation (Emphysema). 76-8). In some cases where US is inconclusive, magnetic resonance imaging (MRI) is performed to differentiate a normal thymus from mediastinal pathology. They can indicate a broad range of conditions, and your doctor may need to do further scans and tests to determine the exact cause of any lung opacities. This condition is also referred to as retained fetal lung fluid or wet-lung syndrome. Bleeding into the lungs may be associated with coughing up blood. A, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Chest, Thyroid, Parathyroid, and Neonatal Brain Ultrasound, Pleura, Chest Wall, Diaphragm, and Miscellaneous Chest Disorders, Pulmonary lymphangiectasia/hemangiomatosis. A brief resolved unexplained event (BRUE), formerly called an apparent life-threatening event, is an event in a newborn or infant lasting less than a minute that is characterized by a sudden change in one of the following: color (central cyanosis or pallor), respirations (absent, decreased, or irregular), tone (hypertonia or hypotonia), or level Potter syndrome, associated with bilateral renal agenesis, congenital renal cystic disease, or obstructive uropathy, Bilateral overaeration of the lungs is most often caused by airway obstruction that can be central or diffuse and peripheral (, Table 50.6 Possible Causes of Bilateral Lung Hyperinflation, A right-sided aortic arch is the key radiographic clue to the presence of an obstructing vascular ring (, The pulmonary sling anomaly is a rare condition that may also result in tracheal compression and bilateral hyperaeration of the lungs. Progressive thinning of the pulmonary interstitium allows gas exchange with approximation of the proliferating capillaries and the type I cells. Neonatal Pneumonia Such hyperaeration may represent obstructive emphysema (, Table 50.7 Causes of Unilateral Obstructive Emphysema. Liu J, Chen X, Li X, Chen S, Wang Y, Fu W. Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn. This article will provide information about lung opacity, whether it means you have lung cancer, and what the outlook may be for those with lung opacity. In these infants the radiographic changes may mimic meconium aspiration syndrome or severe transient tachypnoea. Round pneumonias occur frequently in young children, usually under 8 years of age, due to the presence of immature collateral ventilation pathways between the small airways (Fig. Uneven aeration following surfactant administration. Mandell J. Radiograph demonstrates bilateral pleural effusions (arrows). In children, fluid overload tends to cause peribronchovascular oedema, which then results in overinflation of the lungs due to air trapping, along with perihilar infiltrate and upper lobe venous diversion. These will range from the presentation of congenital abnormalities, infections through to complex immunodeficiency syndromes and malignancy. Typically the radiograph demonstrates interstitial opacification with some hyperinflation. The reticular interstitial pattern refers to a complex network of curvilinear opacities that usually involved the lung diffusely. On a chest x-ray lung abnormalities will either present as areas of increased density or as areas of decreased density. (2013) ISBN: 9781107679689 -. The conditions leading to respiratory distress in the newborn infant are numerous and can be divided into those that can be treated medically and those that require surgical intervention. Opportunistic infections may occur in children with HIV infection and other forms of congenital or acquired immunodeficiency. 76-11). Radiographically, the most common appearances are mild overinflation, prominent blood vessels, perihilar interstitial shadowing and fluid in the transverse fissure with occasional small pleural effusions (Fig. These infants have a mild early course and develop features of BPD at an earlier age than would be expected in a premature infant.8. In most cases, it should not be necessary to seek medical advice. The following 10 methods may help to prevent or treat dry, cracked, or peeling skin. Normal thymic tissue is soft, malleable and compliant; hence, it often undulates beneath the overlying ribs, giving it a lobulated appearance known as the thymic wave. Typically the infants have mild-to-moderate respiratory distress without cyanosis in the first couple of hours. Neonatal chest radiograph in the exam setting. Spontaneous pneumomediastinum outlining the thymus (arrows) and right pneumothorax (arrowhead). In these infants the radiographs do not differ significantly from those infants receiving conventional ventilation. Reid J, Davros W, Paladin A et al. The cause is unknown, and late maturation of the thoracic duct has been suggested as an aetiology. (A) Initial radiograph of a premature neonate born at 24 weeks of gestation, weighing 540 grams shows mild coarsening of interstitial markings (arrowheads). Pulmonary edema can cause perihilar infiltrates. The typical location is lobar or segmental, and associated pleural (parapneumonic) effusions are not uncommon (Fig. That's why its fairly common to have shortness of breath after you've had. Term infant with meconium aspiration undergoing ECMO. Although these patterns have traditionally been associated with viral and bacterial pathogens, studies indicate that prediction of causative pathogen using radiographic patterns is notoriously inaccurate.15 In addition viral and bacterial infection may be present simultaneously, so these classic radiographic patterns are not always accurate. In the premature infant there maybe diffuse fine granular opacification, similar to the appearances seen in IRDS.7 Some infants may have both IRDS and group B streptococcus pneumonia. The thymic size is variable and may alter with the degree of lung inflation. Amniotic fluid is normally expressed from the lungs during vaginal delivery and then absorbed after birth. The tips of those inserted through the lower limbs are usually positioned at the junction of the IVC and the right atrium. 76-18A). Nodular: This. It happens when the skin does not have all the water or naturally occurring oils it needs to maintain itself. Normal Lung Development Acute lower respiratory infection is the leading cause of child death in developing countries. Is the ketogenic diet right for autoimmune conditions? During the saccular phase (2834 weeks) there is an increase in the number of terminal sacs, further thinning of the interstitium, continuing proliferation of the capillary bed and early development of the true alveoli. 5. The anterior mediastinum is the part closest to the sternum or breast bone. clavicular fracture or shoulder/humerus injury, if the child is a little older, rib fractures in non-accidental injury, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. de Matos MJR, et al. Transient tachypnea of the newborn, also known as retained fetal fluid or wet lung disease, presents in the neonate as tachypnea for the first few hours of life, lasting up to one day. Newborn High lung volumes, streaky perihilar densities Low lung volumes, granular opacities Meconium aspiration syndrome Transient tachypnea of the newborn Neonatal pneumonia Surfactant deficiency b-hemolytic streptococcal pneumonia FIGURE 3-1. Lymphocytic infiltrative disease produces a reticulonodular pattern that is indistinguishable from infection (, Pulmonary aeration abnormalities are best evaluated on the chest radiograph by observing the following criteria: (, Pulmonary hypoplasia in the neonate can be unilateral or bilateral. Diffuse: Diffuse opacities show up in multiple lobes of one or both lungs. 4. Fluid in the lungs will be treated based on the cause. Air leaks are common and small associated pleural effusions may be seen. A, Congenital pulmonary airway malformation (cystic adenomatoid malformation), Large Congenital Pulmonary Airway Malformation, Congenital Pulmonary Airway Malformation. This child was admitted to intensive care with severe respiratory distress due to influenza infection. 2014;35(10):417-28; quiz 429. a bit of lung that has blood supply from the aorta and whose parenchyma is not connected to the tracheobronchial tree, it may be consolidated and fluid-filled or undergo cystic change, extralobar sequestration (the less common type) occurs in neonates. Mutations in the SpC are autosomal dominant and may present later in infancy. 1. (2021). Veronica Donoghue, Tom A. Watson, Pilar Garcia-Pea, Catherine M. Owens The chest radiograph may show diffuse hazy opacification initially, with the later development of interstitial shadowing which may be progressive (Fig. There is some question as to whether these opacities represent true airspace consolidations. There is poor lung inflation and aeration with mild diffuse granular opacification in keeping with IRDS. That said, a skin condition like eczema is also a possible cause. At the time the article was created Jeremy Jones had no recorded disclosures. What is ground-glass opacity in the lungs? White opacities in both lungs in someone known to have heart failure is most likely edema or fluid in the lungs. These lipoproteins then combine with surface surfactant proteins (A, B, C, D), which are also produced by the type II pneumocytes to form tubular myelin. Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung. Two different things: "streaky infiltrates" means nothing specific. A rotated patient showing a normal thymus (proven on subsequent radiograph) masquerading as a mediastinal mass. It may also cause a chemical pneumonitis (. However, other tests may be done to confirm the diagnosis or determine the type or severity of atelectasis. This means that the normally dark air filled lung is replaced with a whiter appearance. There can be thickening of the bronchi depending on the cause. Are there different types of opacities in the lung? Infants with large diaphragmatic hernias usually present with severe respiratory distress immediately after birth. Chest radiographic finding in patients with transient tachypnea of newborn in this study showed that hyperinflation with linear streaky perihilar opacities with prominence of interlobar fissure was most common finding of transient tachypnea of newborn (26.32%), followed by only If people avoid washing the vernix off the baby immediately after birth, this natural biofilm may also help the babys skin to adapt to life outside the womb. Depending on the cause, your doctor may suggest: If the lung opacity is due to cancer, treatment will vary depending on the severity and type. Bilateral pulmonary hypoplasia is most often the result of compression of the lungs during fetal development. High-frequency ventilation is also used to reduce the incidence of barotrauma, particularly in the very premature infant. The left lung is more hyperlucent than the right and there is a paucity of left-sided vascular markings. (2020). There may be additional helpful findings and clinical history to indicate this diagnosis. Chest radiograph at 4 weeks of age demonstrates hyperinflation, interstitial and alveolar opacification throughout both lungs in keeping with BPD. The undulated appearance of the left thymic border is due to rib indentation (arrow). (A) Term infant. Is It Normal to Have Shortness of Breath After COVID-19? Lin YH, et al. Lateral views tend only to be performed after review of the frontal radiograph, when there are unanswered clinical questions. The appearances in some areas mimic those of PIE. Atelectasis is one of the most common breathing (respiratory) complications after surgery. Cardiogenic pulmonary edema occurs when the pulmonary venous pressures are elevated because of left-sided myocardial failure or congenital lesions that impede blood flow through the left side of the heart (e.g., pulmonary vein atresia, cor triatriatum, hypoplastic left heart syndrome). (B) There is almost complete resolution at 24 hours. The alveolar phase extends from approximately 36 weeks gestation until 18 month of age, with most alveoli formed at 56 months of age. Cleveland R. A Radiologic Update on Medical Diseases of the Newborn Chest. Normally the lung is black in this region. Disorders of surfactant deficiency due to a genetic abnormality in the surfactant protein B (SpB)9 and C (SpC)10 and the ATP-binding cassette transporter protein A3 (ABCA3) can lead to interstitial lung disease. BlalockTaussig shunt, Constrictive bronchiolitisformerly known as SywerJames syndrome, External mass compressionmediastinal mass compressing a bronchus, Endobronchial lesione.g. (A) CXR shows bilateral interstitial, granular and fluffy opacification.