Which radiographic finding is most characteristic of neonatal RDS?

• A. Diffuse hazy opacities with low lung volumes and air bronchograms.
• B. Hyperinflation with perihilar markings.
• C. Hyperdense lobar consolidation.
• D. No radiographic abnormality.

Answer: (B)

Surfactant deficiency in the newborn leads to widespread under-aeration of the lungs, producing a distinctive chest radiograph pattern. The classic image shows diffuse hazy, ground-glass–like opacities with relatively low lung volumes, and air bronchograms—the air-filled bronchi stand out against the opacified, collapsed alveoli. This combination is what clinicians look for as the hallmark of neonatal RDS on imaging.

Other patterns don’t fit as well. Hyperinflation with perihilar markings is more typical of transient tachypnea of the newborn, where fluid clearance is delayed but the lungs are overexpanded. Hyperdense lobar consolidation would suggest a focal pneumonia or aspiration, not the diffuse, bilateral picture of RDS. No radiographic abnormality would be unlikely in a clinically evident case of neonatal RDS.

So, the diffuse hazy opacities with low lung volumes and air bronchograms best reflect the classic radiographic appearance of neonatal RDS.