The radiographic findings of pulmonary hemorrhage are difficult to distinguish from which condition?

• A. Meconium aspiration syndrome (MAS)
• B. Pneumothorax
• C. Respiratory distress syndrome (RDS)
• D. Pulmonary edema

Answer: (A)

Neonatal chest radiographs can show alveolar filling that isn’t specific to one disease. Pulmonary hemorrhage fills the alveoli with blood, producing patchy or confluent air-space opacities that are often perihilar or diffuse and may include air bronchograms. This pattern overlaps strongly with meconium aspiration syndrome, which also presents with diffuse hazy infiltrates and air bronchograms. Because both conditions can look very similar on X-ray, it can be difficult to distinguish them based on radiographs alone.

By comparison, pneumothorax would show a pleural line with absent markings beyond it on the affected side; respiratory distress syndrome typically shows a reticulogranular pattern with low lung volumes; pulmonary edema tends to have vascular congestion and sometimes cardiomegaly. Hence the radiographic appearance of pulmonary hemorrhage most closely mimics MAS.