Bilateral Pneumothorax vs. Right-sided Lung Cyst

Left picture: This newborn has a bilateral pneumothorax more on the right than on the left side. The shape of the collapsed lung and its central localization allows the diagnosis together with the clear zone without lung structure at the periphery, and mainly on the right side. Right picture: The diagnosis of this young infant is not a pneumothorax. Neither the history with increasing respiratory symptoms and signs, nor the shape of the clear zone without lung structure and medial and concave boundary fit the picture of a pneumothorax. The diagnosis is a multilocular cyst of the lower lung lobe which displaces the intact lung in a medial and upper direction and causes the described concave edge due to an increasing overdistension of the malformation.

Left picture: Upright chest x-ray in a newborn with RDS. Clear parts without any lung structure are visible in this newborn on both sides; in the upper field and in the periphery of the right hemithorax a clear zone is recognizable without any pattern of lung structure. Right picture: Chest x-ray of a young infant with increasing respiratory symptoms up to a thoracic emergency. The lower and the middle right hemothorax is bright and without any recognizable structure.