Snow White’s X-Ray Phenomena

Radiology tutorials make me sleepy. I don’t find them boring, strangely… they just send me straight into narcoleptic episodes. But this one was fun:

Basically, neonatal X-rays (yes, they do periodically expose those little things to X-rays) can be divided into different presentations.

Grainy, Streaky, Blacky, Fluffy, Hazy, Bubbly and Dotty. And of course, Snow White.

Grainy and Hazy chest X-rays are characteristic of Hyaline Membrane Disease, which is caused by surfactant deficiency in the newborn. This leads to low lung volume and is quite common in premature infants. It’s often described as a ground-glass picture.

The consultant didn’t really elaborate on Fluffy and Dotty, so if you know them be sure to introduce me.

Streaky chest X-rays are associated with Transient Tachypnoea of the Newborn. Unlike HMD, TTN is more common in term infants without labour complications. The disease is said to be mostly self-limiting. These X-rays are said to resemble “streaks”, usually with a very prominent illustration of the transverse fissure of the right lung. TTN is also sometimes referred to as a “wet lung”.

Blacky is just that: a very black lung, indicative of a pneumothorax.

Bubbly is my favourite because he displays exactly like you would expect: bubbly. Unlike Grainy and Streaky and Hazy which really might as well be the same damn thing. Bubbly is caused by a diaphragmatic hernia – not fun, but easy to recognize.

And Snow White? Generally an under-exposed X-ray, that looks snowed-under and all white.

Obviously I can’t walk into an exam and say, oh this is Bubbly and blah-blah. One must actually be able to know the clinical relevance. But that’s not asking too much for a doctor and this remains a fun way of making the learning process easier.