Progressive chest radiographic changes in wet lung disease.

Delayed clearance of fetal lung fluid, or wet lung disease (WLD), is a common, well described clinico-radiographic diagnosis. Unusual chest roentgenographic findings in six infants with WLD are reported. All infants had either delayed development of pleural fluid collections or transient apparent worsening of pulmonary parenchymal infiltrates simulating infection. Five of the six patients were treated with antibiotics. The patients were clinically well, radiographically normal, and culture negative by 72 hours. Our findings suggest that worsening of pulmonary parenchymal opacities and the appearance of pleural effusions can be part of the WLD spectrum. An initial radiographic impression of neonatal pneumonia can be changed to WLD and antibiotics stopped after 72 hours if subsequent radiographs show clearing, cultures are negative, and clinical findings resolve as they did in our patients.