Purpose or Case Report: With advances in intensive care, increasing numbers of premature neonates with severe respiratory distress have led to major challenges related to prolonged mechanical ventilation and chronic bronchopulmonary dysplasia. Acute lung injury and acute respiratory distress syndrome in children still confer significant morbidity and mortality despite advances in ventilation and resuscitative therapies.

Much of the damage attributed to mechanical ventilation in critically ill infants and children is due to surface tension and ventilation of atelectatic lung. First reported clinically in neonates in 1989, partial liquid ventilation involves the endotracheal administration of an inert volatile perfluorochemical liquid. These perfluorocarbons aid in gas exchange due to their large oxygen and carbon dioxide carrying capacity. In addition, these chemicals possess low surface tension that allows for greater alveolar recruitment and improved lung compliance through clearance of debris and secretions.

Early trials in preterm neonates and neonates with congenital diaphragmatic hernia suggested a role for liquid ventilation as salvage therapy for patients not responding to conventional mechanical ventilation and extracorporeal membrane oxygenation. Currently, efforts are underway to reassess its clinical utility in bronchopulmonary dysplasia. With this renewed clinical interest, it is important for pediatric radiologists at institutions utilizing these perfluorocarbons to be familiar with the clinical use and radiographic appearance of liquid ventilation.
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Results:
Conclusions: This presentation summarizes the imaging evaluation of liquid ventilation including information on the qualitative assessment of ventilation status and clinical relevance of particular imaging findings. Due to the presence of bromine, these perfluorocarbons demonstrate a strikingly radiopaque appearance on chest radiographs and computed tomography that can be confusing to radiologists unfamiliar with liquid ventilation. Understanding the radiographic distribution and clearance of perfluorocarbons from the lungs can be important in assessing the effectiveness of this experimental therapy. In addition, radiologists should be aware of the occasional retention of perfluorocarbons in extra-pulmonary tissues following discontinuation of liquid ventilation.