Chest radiographs in respiratory distress syndrome most characteristically show:

• A. Clear lungs
• B. Ground-glass appearance with diffuse atelectasis and air bronchograms
• C. Cardiomegaly without edema
• D. Lobar consolidation with effusion

Answer: (B)

RDS in newborns stems from surfactant deficiency, which makes the lungs stiff and prone to alveolar collapse. On chest radiographs this leads to widespread, subtle haziness with low lung volumes—a diffuse reticulogranular or “ground-glass” appearance due to diffuse atelectasis. The collapsed alveoli contrast with the still-air-filled bronchi, so you see air bronchograms running through the lungs. This combination—diffuse involvement with air bronchograms—is the classic radiographic pattern for respiratory distress syndrome.

Other patterns don’t fit this scenario: clear lungs would not be expected in RDS; focal lobar consolidation with effusion suggests pneumonia with pleural fluid; cardiomegaly without edema points toward cardiac causes rather than surfactant deficiency.