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A 25-week infant, born in a level one unit, was intubated, ventilated and transferred to the tertiary neonatal centre without incident. He had acute respiratory collapse on day 2 with a right-sided tension pneumothorax (figure 1A), which was drained. He remained stable until day 7 when he deteriorated, with increased oxygen requirement and poor feed tolerance (figure 1B). On review, there were gastric tube aspirates over the preceding days with high pH (>6–8), consisting mainly of large volumes of undigested milk.
What do these radiographs show?
What is your differential diagnosis?
What would your concerns be?
How would you manage this?
Answers can be found on page 2.
ANSWERS TO THE QUESTIONS ON PAGE 1
The first image shows a right-sided tension pneumothorax. The gastric tube tip projects …
Contributors CLG, RT and CA were responsible for the original concept for the article. CLG wrote the initial manuscript. RT and CA were both involved in editing and rewriting.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.