Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jan;35(1):e1-e5.
doi: 10.1097/PEC.0000000000000916.

Unilateral Lung Whiteout in Children: Four Cases and a Discussion of Management

Itaru Iwama  1 , Moriyasu Kohama
Affiliations
Review

Unilateral Lung Whiteout in Children: Four Cases and a Discussion of Management

Itaru Iwama et al. Pediatr Emerg Care. 2019 Jan.

Abstract

Unilateral lung whiteout is not a common pediatric chest radiograph finding, but when it is encountered, timely and accurate interpretations of the radiograph are required because life-threatening respiratory failure can be associated. Lung whiteout may result from several conditions, and the differential diagnosis has a broad range. We describe 4 pediatric patients with different etiologies of unilateral lung whiteout: a large pleural effusion, mainstem bronchial plugging with a large cast, a mediastinal tumor, and consolidation. The ultimate causal diagnosis may not be initially obvious, but valuable clues can usually be found in the conventional chest radiograph to assist with appropriate early management. Chest ultrasound provides additional information, and we recommend it as the second examination for such patients.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
A, Chest radiograph showing whiteout of the left lung with contralateral mediastinal position. B, Chest CT scan demonstrating large pleural effusion surrounding the collapsed left lung.
FIGURE 2
FIGURE 2
A, Chest radiograph showing whiteout of the left lung with ipsilateral mediastinal shift. B, Chest CT scan demonstrating total atelectasis of the left lung. C, Bronchoscopic view of the bronchial cast occluding the left main bronchus. D, Branching bronchial cast.
FIGURE 3
FIGURE 3
A, Chest radiograph showing whiteout of the left lung with contralateral mediastinal shift. Nasogastric tube and tracheal tube deviated to the right side. B, Bronchoscopic view of extrabronchial compression of the left main bronchus. C, Enhanced chest CT scan demonstrating a large homogenous tumor in the anterior mediastinum.
FIGURE 4
FIGURE 4
A, Chest radiograph showing whiteout of the right lung with central mediastinal position. B, Enhanced chest CT scan demonstrating total consolidation of the right lung.
FIGURE 5
FIGURE 5
Diagnostic flowchart for children with unilateral lung whiteout.
See this image and copyright information in PMC

References

    1. Alford BA, McIlhenny J, Jones JE, et al. Asymmetric radiographic findings in the pediatric chest: approach to early diagnosis. Radiographics. 1993;13:77–93. - PubMed
    1. Hendry GM. The case of the opaque hemithorax. Paediatr Respir Rev. 2000;1:294–298. - PubMed
    1. Berant R, Kwan C, Fischer J. Emergency point-of-care ultrasound assessment of whiteout lung in the pediatric emergency department. Pediatr Emerg Care. 2015;31:872–875. - PubMed
    1. Brogan TV, Finn LS, Pyskaty DJ, Jr, et al. Plastic bronchitis in children: a case series and review of the medical literature. Pediatr Pulmonol. 2002;34:482–487. - PubMed
    1. Debnath J, Jain NK, Adhikari KM, et al. A child with respiratory distress having unilateral obstructive emphysema and contralateral opaque hemithorax on chest radiograph: role of multi-detector computerized tomography with multi-planar reconstruction and virtual bronchoscopy. Australas Radiol. 2007;51:B217–B220. - PubMed