It may not be evenly distributed throughout the lungs, leading to areas of atelectasis interspersed with areas of good aeration, and may produce radiographic findings similar to neonatal pneumonia or pulmonary interstitial emphysema (PIE) (Fig. It may migrate to the distal airways, causing complete or partial obstruction and lead to a ball-valve effect. Lung opacity can indicate different conditions that have their own treatment plans. This results in inadequate gas exchange, leads to prolonged ventilation, hazy lung opacification and occasionally a picture similar to that seen in bronchopulmonary dysplasia (Fig. Ground-glass opacity can be a sign of: Ground-glass opacity can result from a variety of causes, according to 2020 research. Some pneumonias may require antibiotics while others need supportive care like viral pneumonias. de Matos MJR, et al. Case 2: congenital tracheo-esophageal fistula, see full revision history and disclosures, acute unilateral airspace opacification (differential), acute bilateral airspace opacification (differential), acute airspace opacification with lymphadenopathy (differential), chronic unilateral airspace opacification (differential), chronic bilateral airspace opacification (differential), osteophyte induced adjacent pulmonary atelectasis and fibrosis, pediatric chest x-ray in the exam setting, normal chest x-ray appearance of the diaphragm, posterior tracheal stripe/tracheo-esophageal stripe, obliteration of the retrosternal airspace, Anti-Jo-1 antibody-positive interstitial lung disease, leflunomide-induced acute interstitial pneumonia, fibrotic non-specific interstitial pneumonia, cellular non-specific interstitial pneumonia, respiratory bronchiolitisassociated interstitial lung disease, diagnostic HRCT criteria for UIP pattern - ATS/ERS/JRS/ALAT (2011), diagnostic HRCT criteria for UIP pattern - Fleischner society guideline (2018), domestically acquired particulate lung disease, lepidic predominant adenocarcinoma (formerly non-mucinous BAC), micropapillary predominant adenocarcinoma, invasive mucinous adenocarcinoma (formerly mucinous BAC), lung cancer associated with cystic airspaces, primary sarcomatoid carcinoma of the lung, large cell neuroendocrine cell carcinoma of the lung, squamous cell carcinoma in situ (CIS) of lung, minimally invasive adenocarcinoma of the lung, diffuse idiopathic pulmonary neuroendocrine cell hyperplasia (DIPNECH), calcifying fibrous pseudotumor of the lung, IASLC (International Association for the Study of Lung Cancer) 8th edition (current), IASLC (International Association for the Study of Lung Cancer) 7th edition (superseeded), 1996 AJCC-UICC Regional Lymph Node Classification for Lung Cancer Staging, 4ways diagostics, I work for this out sourcing company during non NHS hours (ongoing), differential diagnoses of airspace opacification, presence of non-lepidic patterns such as acinar, papillary, solid, or micropapillary, myofibroblastic stroma associated with invasive tumor cells. A lung PET scan is used to take. Also, prostaglandins dilate pulmonary lymphatics to absorb excess fluid. Nodular: This. {"url":"/signup-modal-props.json?lang=us"}, Agrawal R, Vadera S, Northam N, et al. 5. Uneven aeration following surfactant administration. 10 of the best lotions for dry skin of 2022. Atelectasis happens when lung sacs (alveoli) can't inflate properly, which means blood, tissues and organs may not get oxygen. Prenatal corticosteroid administration during the 2 days prior to delivery significantly reduces the incidence of IRDS in premature infants. The lack of, or reduction in, vascular markings is usually due to the presence of primary airways disease in children and the resultant homeostatic reflex vasoconstriction (Table 76-1) (Fig. 4. You can learn more about how we ensure our content is accurate and current by reading our. Mixed patterns also occur. The reticular interstitial pattern refers to a complex network of curvilinear opacities that usually involved the lung diffusely. There may be additional helpful findings and clinical history to indicate this diagnosis. Some potential reasons for lung opacity include: Depending on the type of opacity found, your doctor may also do cardiac testing to determine if heart conditions are playing a role. The Lungs Perihilar infiltrates is an abnormality seen on chest X-rays and CT around the hila either on one or both sides. There is bilateral asymmetrical coarse pulmonary opacification and small bilateral pleural effusions (arrows). There is some question as to whether these opacities represent true airspace consolidations. Transient tachypnea is one of the most common causes of neonatal respiratory distress, particularly in term or near term newborns. 76-24). This child was admitted to intensive care with severe respiratory distress due to influenza infection. Fluid in the lungs will be treated based on the cause. This is the principal contributor at the alveolar airfluid interface which lowers alveolar surface tension and prevents acinar collapse on expiration. 76-10). 76-19). The definition of meconium aspiration syndrome is an infant born through meconium-stained amniotic fluid where the symptoms cannot be otherwise explained.6 It is thought that fetal hypoxia causes fetal intestinal hyperperistalsis and passage of meconium, which is aspirated by a gasping fetus. Spontaneous pneumomediastinum outlining the thymus (arrows) and right pneumothorax (arrowhead). (2014). cystic change) or predisposing factors, e.g. Part of the treatment for the newborns peeling skin involves keeping the baby as comfortable as possible. This causes consolidation within the air spaces and results in the presence of air bronchograms seen on radiographs. A newborns skin is very sensitive. Radiographically, the most common appearances are mild overinflation, prominent blood vessels, perihilar interstitial shadowing and fluid in the transverse fissure with occasional small pleural effusions (Fig. A, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Chest, Thyroid, Parathyroid, and Neonatal Brain Ultrasound, Pleura, Chest Wall, Diaphragm, and Miscellaneous Chest Disorders, Pulmonary lymphangiectasia/hemangiomatosis. ECMO has improved the survival of some patients by circumventing the problem of pulmonary hypertension and the right-to-left shunting of blood away from the lungs. Nasogastric tube tip positions should always be reported on, in order to avoid misplacement of nasogastric feeds. Liu J, Chen X, Li X, Chen S, Wang Y, Fu W. Lung Ultrasonography to Diagnose Transient Tachypnea of the Newborn. Debra Sullivan, Ph.D., MSN, R.N., CNE, COI, What You Need to Know About RSV and Pneumonia. How do you tell if youre experiencing lung opacities? 76-21) and relative lucency of one lung compared to the other, simulating oligaemia/air trapping. Infant with surfactant dysfunction disorder (ABCA3). Most of the time, newborn skin peeling is normal. Air leaks, patent ductus arteriosus and infection are contributing factors as they also prolong ventilation. A rotated patient showing a normal thymus (proven on subsequent radiograph) masquerading as a mediastinal mass. Various appearances of a normal thymus in newborn. Cancerous perihilar infiltrates may need chemotherapy or other cancer treatments. Anything that causes the normal air filled dark lungs to lose this appearance and be whiter can be referred to as perihilar infiltrates. Pediatric Radiology. This can help to prevent secondary exposure to these chemicals. A pneumomediastinum usually outlines the thymus (Fig. When the chest radiograph also includes the abdomen, look out for the umbilical clip. Inhalational injury, bleeding into the lungs, and certain cancers can also occasionally have this appearance. Newborn skin peeling is normal in the first days to weeks after a baby is born. Inherited mutations in the SpB and ABCA3 are autosomal recessive and may present immediately after birth with respiratory symptoms. Unable to process the form. clavicular fracture or shoulder/humerus injury, if the child is a little older, rib fractures in non-accidental injury, ADVERTISEMENT: Supporters see fewer/no ads, Please Note: You can also scroll through stacks with your mouse wheel or the keyboard arrow keys. Even though over 80 million people undergo computed tomography (CT) scans each year in the United States, some of the words and phrases related to this imaging test can be complicated and hard to understand. The imaging features may be similar to those seen in the other disorders of surfactant deficiency. A, Congenital pulmonary airway malformation (cystic adenomatoid malformation), Large Congenital Pulmonary Airway Malformation, Congenital Pulmonary Airway Malformation. Most people expect newborn babies to have soft, flawless skin, and new parents or caregivers often express concern if their newborns have imperfect skin. It may involute rapidly with prenatal or postnatal stress, for example in severe illnesses such as hyaline membrane disease or infections, or following corticosteroid treatment. An understanding of the causes of these various patterns is necessary to provide a useful interpretation of abnormal lung opacities in children. 76-9). There are differences and similarities between RSV vs. a cold. Lung opacities can indicate many conditions besides cancer. In these infants the radiographs do not differ significantly from those infants receiving conventional ventilation. It is classically described on a frontal chest radiograph but can also refer to appearances on chest CT 3,4. There is cardiac enlargement, splaying of the carina indicating left atrial enlargement, prominent pulmonary vasculature and hazy opacification centrally, suggestive of a left-to-right shunt at PDA level. The hila are seen on the right and left sides where the lung meets the mediastinum. 3. Peeling skin on a newborn baby is quite common and not usually a cause for concern. Unable to process the form. (A) Term infant. Group B streptococcus is the most common organism identified. This reduced clearance of fluid from the lungs is why some have proposed that it is more commonly seen in cesarean section deliveries since the thoracic compression that would occur in a normal vaginal delivery does not take place. Premature infants are at an increased risk of pneumonia, which may coexist with IRDS. That's why its fairly common to have shortness of breath after you've had. Infections acquired perinatally can occur via ascending infection from the vagina, transvaginally during birth or as a hospital-acquired infection in the neonatal period. Are there different types of opacities in the lung? The imaging features may be similar to those seen in the other disorders of surfactant deficiency. not be relevant to the changes that were made. Dr. Adam W. DeTora (Pediatrics): A newborn boy was admitted to this hospital be- . Bilateral upper lobe segmental atelectasis. The thymus may involute during periods of illness, severe stress or whilst on steroids or other chemotherapy. Huang C, et al. Chest radiographic finding in patients with transient tachypnea of newborn in this study showed that hyperinflation with linear streaky perihilar opacities with prominence of interlobar fissure was most common finding of transient tachypnea of newborn (26.32%), followed by only The radiological features are non-specific. In some cases where US is inconclusive, magnetic resonance imaging (MRI) is performed to differentiate a normal thymus from mediastinal pathology. Opportunistic infections may occur in children with HIV infection and other forms of congenital or acquired immunodeficiency. As newborn chest radiographs are taken in the AP plane, the normal cardiothoracic ratio can be as large as 60%. The lipoproteins are produced in the type II pneumocytes, are concentrated in the cell lamellar bodies and then transported to the cell surface and expressed onto the alveolar luminal surface. What is ground-glass opacity in the lungs? Our website services, content, and products are for informational purposes only. proteins (A, B, C, D), which are also produced by the type II pneumocytes to form tubular myelin. The cause is unknown, and late maturation of the thoracic duct has been suggested as an aetiology. Table 50.3 Causes of Parahilar Peribronchial Opacity Atelectasis is the main cause of this opacification, but in the very premature infant in particular, oedema, haemorrhage and occasionally superimposed pneumonia contribute. Depending on the cause, your doctor may suggest: If the lung opacity is due to cancer, treatment will vary depending on the severity and type. Normally the lung is black in this region. Subsequent chest radiographs showed streaky perihilar opacities that were thought to be con- A new type of BPD was described by Jobe in 19995 in immature infants with minimal lung disease at birth, and who become symptomatic during the first week of life. Normal thymic tissue is soft, malleable and compliant; hence, it often undulates beneath the overlying ribs, giving it a lobulated appearance known as the thymic wave. A 2019 study found that in cases when lung opacity showed cancer, pure ground-glass opacity nodules were more likely to be seen in earlier stages of lung cancer. Newborn chest radiograph shows normal to large lung volumes, increased . The anterior mediastinum is the part closest to the sternum or breast bone. Interstitial. 76-25).16 Streptococcus pneumoniae is the causative pathogen in >90% of normal hosts. The blood vessels and bronchi (airways) enter and leave the lungs here. Other imaging findings and the clinical history can help us narrow the diagnosis. Instead, a newborns skin may look dry and begin to peel off. Typically, the lungs appear black on a CT scan or X-ray. The vast majority of upper respiratory tract infections in childhood are viral in nature and primarily bronchial in location. The process resolves rapidly with almost complete resolution in 48 hours. Compression of the ipsilateral lung in utero causes it to be hypoplastic, and often the contralateral lung is also small. 76-7) and pneumopericardium (Fig. Transient tachypnea of the newborn. Infant with group B streptococcus infection. Rebound hyperplasia of the thymus may then occur following recovery or cessation of therapy, and this should not be confused with the development of a pathological mediastinal mass. For example, one term that healthcare professionals might use in reference to a lung CT scan is opacity. This is a radiological term that refers to the hazy gray areas on images made by CT scans or X-rays. These lipoproteins then combine with surface surfactant proteins (A, B, C, D), which are also produced by the type II pneumocytes to form tubular myelin. see full revision history and disclosures, Transient tachypnoea of the newborn (TTN), 1. 76-19) or in some institutions inferior to L3 vertebral bodies. This may help us narrow the diagnostic possibilities. Consolidations with viral infections are not particularly common but can occur with more serious viral infection, such as adenovirus, influenza, parainfluenza, and respiratory syncytial virus. ADVERTISEMENT: Radiopaedia is free thanks to our supporters and advertisers. Infection with common viral, bacterial, and fungal organisms creates a pattern similar to that seen in immunocompetent children, but the findings tend to be more rapidly progressive and more pronounced. These will range from the presentation of congenital abnormalities, infections through to complex immunodeficiency syndromes and malignancy. The extent of the skin peeling will vary according to the babys gestational age at birth. Reference article, Radiopaedia.org (Accessed on 01 May 2023) https://doi.org/10.53347/rID-16903. The prognostic significance of pure ground glass opacities in lung cancer computed tomographic images. What could they show you on a neonatal film? One to two layers of skin will shed in this time, mainly because the protective coating they had in the womb is no longer there. Although the hernia itself is most often unilateral, the increased volume of the thorax on the side of the hernia causes compression of the contralateral lung, resulting in bilateral and asymmetric lung hypoplasia (, Extrathoracic compression of the fetal lungs is most often caused by oligohydramnios secondary to fetal urinary tract abnormalities or by abnormal amniotic fluid production or leakage. Their lungs are structurally and biochemically immature and require prolonged ventilatory support. Your doctor may recommend additional testing to determine the exact cause of any potential lung issues. (B, C) Two axial CT slices demonstrate ground-glass opacification and septal thickening, giving a crazy paving appearance similar to the pattern typically described in alveolar proteinosis. In the very premature infant, less than 27 weeks gestation, the lungs become clear following surfactant administration, but they are still immature with fewer alveoli than normal. CT is good at diagnosing some of the benign and life threatening conditions that can, Read More CT of the Chest for Chest PainContinue, Please read the disclaimer Lateral view chest X-ray is an X-ray done from the side of the chest. Two radiographs of the same patient highlight the problems in interpreting radiographs taken in poor inspiration. Veronica Donoghue, Tom A. Watson, Pilar Garcia-Pea, Catherine M. Owens The ideal position is at the junction of the IVC and the right atrium (Fig. The use of positive pressure ventilation in the newborn is the most common cause of pneumothorax, pneumomediastinum, pulmonary interstitial emphysema (Fig. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Retained fetal fluid (transient tachypnea of the newborn) Retained fetal fluid, also known as transient tachypnea of the newborn, is a diffuse lung disorder that occurs because of delayed clearance of fetal lung fluid after birth, typically in full-term neonates born via cesarean delivery. newborn. In other cases, it can signify a chronic or more serious condition. Healthline Media does not provide medical advice, diagnosis, or treatment. The chest radiograph is the most frequently requested radiological investigation encountered within paediatric practice, and although pathological manifestations may mimic that seen in adults, a thorough knowledge of the variations within paediatric practice is vital to the general radiologist. Baths can have an adverse effect on a babys skin. When the chest radiograph also includes the abdomen, look out for the umbilical clip. Perihilar infiltrates: summary. Pneumonias may have more recent onset with cough, fever, and breathlessness while cancer is a more long standing progressive process. Chest radiograph at 4 weeks of age demonstrates hyperinflation, interstitial and alveolar opacification throughout both lungs in keeping with BPD. The clinical use of artificial surfactant, given as a liquid bolus through the endotracheal (ET) tube, has been a major therapeutic advance. The rigid lungs caused by IRDS and the associated hypoxia and hypercarbia may lead to right-to-left shunting through the ductus. There are much better tests to look, Read More Can A CT Chest CT Show A Heart Problem?Continue, Please read the disclaimer Chest X-ray is a common test ordered to evaluate chest pain. Neonatal Chest Imaging. Lin YH, et al. It is a thick viscous substance and may lead to areas of atelectasis and overinflation. Due to this, their skin does not exfoliate as adults skin does. Treatment is usually possible using home remedies, and medical intervention is rarely necessary. Skin folds may be visible over the chest wall and may mimic a pneumothorax. They can indicate a broad range of conditions, and your doctor may need to do further scans and tests to determine the exact cause of any lung opacities. This can tell us that the process is more localized to one area. Bilateral pulmonary hypoplasia is most often the result of compression of the lungs during fetal development. In TTN the normal physiological clearance is delayed. Medical imaging advances may reduce radiation risk for vulnerable patients. Fowler Jr., J. F. (2014, October). Most likely they represent intense interstitial disease compressing the alveoli. Noncardiogenic causes of pulmonary edema predominate in children. Meconium Aspiration Syndrome Some conditions will result in multiple types of opacities. There is almost complete white-out of the lungs with air bronchograms. All rights reserved. It may also cause a chemical pneumonitis (. Pediatr Radiol. Congenital diaphragmatic hernia may occasionally be minimally symptomatic at birth, presenting later in life. What causes skin on the fingertips to peel? The most common imaging findings were mixed airspace/interstitial opacities (39.8%) on CXR and peripheral GGOs on CT (92%). Clinically these premature infants are usually symptomatic within minutes of birth with grunting, retractions, cyanosis and tachypnoea. Differential diagnosis Bat wing pulmonary opacities can be caused by: pulmonary edema (especially cardiogenic) pneumonia Limiting the amount of time in the bathtub. 76-1) or it may exhibit the classic sail sign more commonly seen on the right side. Pulmonary edema or fluid in the lungs may be seen from multiple causes but is commonly seen in patients with heart failure. The symptoms often depend on the cause. Radiograph demonstrates bilateral pleural effusions (arrows). How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction, Complementary Medicine / Alternative Medicine, http://americanpregnancy.org/while-pregnant/second-trimester/, http://jddonline.com/articles/dermatology/S1545961614P1180X, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574071, https://kidshealth.org/en/parents/newborn-variations.html?ref=search&WT.ac=msh-p-dtop-en-search-clk, https://med.stanford.edu/newborns/professional-education/photo-gallery/skin.html#normal_peeling, https://www.sciencedirect.com/science/article/pii/S0738081X14003022?via%3Dihub, One-hour endoscopic procedure could eliminate the need for insulin for type 2 diabetes, New clues to slow aging? The circulation bypasses the lungs, which are minimally inflated, and allows physiologic levels of oxygen saturation. Other imaging findings and the clinical history can help us . Chapter 76 1. The thymic size is variable and may alter with the degree of lung inflation. A, Congenital Lobar Hyperinflation (Emphysema). Resolution is usually complete but often after multiple aspirations. with conditions that affect lung growth and the diagnosis is made by the pathological examination of lung tissue. Surfactant Dysfunction Disorders The presence of pleural effusions, pulmonary hyperinflation and mild cardiomegaly may not be helpful in differentiating pneumonia from these other conditions. Pure nodules do not contain any solid mass, whereas partially solid nodules do have solid components. There are multiple causes of perihilar infiltrates. Bleeding into the lungs may be associated with coughing up blood. Typically the radiograph demonstrates interstitial opacification with some hyperinflation. MNT is the registered trade mark of Healthline Media. The umbilical stump remains in situ for approximately 1-2 weeks and its presence helps to age the baby. The unchanged overall incidence is due to the increased survival of the infants of extreme prematurity as they require more prolonged ventilation. The incidence is greater in infants delivered by Caesarean section, in hypoproteinaemia, hyponatraemia and maternal fluid overload. they cannot be bronchi). Normal Anatomy and Artefacts Neonatal Pneumonia A large, hyperlucent hemithorax most often indicates overinflation of an entire lobe or lung. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. Using lukewarm water to clean the baby. The whiteness still allows you to see the blood vessels and bronchi through the opacities. Reid J, Davros W, Paladin A et al. The features may simulate meconium aspiration syndrome and congenital neonatal pneumonia, particularly when severe. This can lead to cracks in the skin and peeling. This term does not imply a specific diagnosis but simply that an abnormality is observed around the hila. Nodules or masses. distended pouch of gas in the upper mediastinum, if the examiner is being kind, it will have an NG tube looped in it, if there is gas in the stomach, there must be an accompanying congenital tracheo-esophageal fistula, birth related injury, e.g. Tracheal and left main bronchus stents can be seen in this patient with known tracheobronchomalacia. Ground-glass opacity is a radiological term that refers to hazy gray areas on the images made by CT scans or X-rays. Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung. {"url":"/signup-modal-props.json?lang=us"}, Jones J, Bickle I, Bell D, et al. (2016, September 16). Cardiac or Respiratory? Radiographs shows a rounded or spherical opacity with poorly defined margins, unlike a primary or metastatic chest tumour (which are usually very well circumscribed).17. There are many home remedies that people can use to help protect a newborns skin. During the saccular phase (2834 weeks) there is an increase in the number of terminal sacs, further thinning of the interstitium, continuing proliferation of the capillary bed and early development of the true alveoli. Become a Gold Supporter and see no third-party ads. If people avoid washing the vernix off the baby immediately after birth, this natural biofilm may also help the babys skin to adapt to life outside the womb. What to Know About RSV, Medicine, and Treatments That Can Help, fluid, pus, or cells filling the air space, coughing with yellow, green, or bloody mucus, steroid medications to reduce inflammation. 76-12). Atelectasis usually resolves after treating the underlying cause. Newborn babies have just spent 9 months surrounded by amniotic fluid. Become a Gold Supporter and see no third-party ads. The tip of the umbilical venous catheter is in the IVC (short arrow) and should ideally be placed more distally in the IVC close to the right atrium. Clear vision through the haze: A practical approach to ground-glass opacity. The right thymic margin can often have a sharp sail-like configuration (Fig. There is also a right pneumothorax. It can be caused by pressure outside of your lung, a blockage, low airflow or scarring. For people at high risk, such as those with compromised immune systems and the very. 76-15). Very premature infant born at 24 weeks gestation. During the pseudoglandular phase (616 weeks) there is airway development to the level of the terminal bronchioles, with a deficient number of alveolar saccules. There is bilateral asymmetrical coarse opacification in the lungs in keeping with meconium aspiration. The plain chest radiograph remains the first radiological examination in use for the evaluation of the chest in children. The tips of those inserted through the lower limbs are usually positioned at the junction of the IVC and the right atrium. These infants are usually full term or slightly preterm. Your doctor may suggest a scan of your lungs if you are experiencing: Opacities are also likely to show up on a scan if you have a history of smoking or vaping. The degree of rotation is best assessed by comparing the length of the anterior ribs visible on both sides. Correlation with the clinical picture is, therefore, very important. This is the root of the lung on each side. Potter syndrome, associated with bilateral renal agenesis, congenital renal cystic disease, or obstructive uropathy, Bilateral overaeration of the lungs is most often caused by airway obstruction that can be central or diffuse and peripheral (, Table 50.6 Possible Causes of Bilateral Lung Hyperinflation, A right-sided aortic arch is the key radiographic clue to the presence of an obstructing vascular ring (, The pulmonary sling anomaly is a rare condition that may also result in tracheal compression and bilateral hyperaeration of the lungs. (2021). Prominent/enlarged generalised lung parenchymal vessels could indicate the presence of a left-to-right shunt at either intracardiac or great vessel level. Newborn skin peeling is usually a natural consequence of pregnancy. Surgical conditions consist primarily of congenital and developmental abnormalities that result in a space-occupying lesion within the chest (diaphragmatic hernia, congenital lobar emphysema, chylothorax, pneumothorax, cystic adenomatoid malformation). Limiting a babys exposure to cold air can help to prevent this. Such infections may result in pulmonary opacities that differ significantly from those seen with bacterial pneumonia. A humidifier will increase the amount of moisture in the room. Its also good to know that chest CTs are used to screen for risk of lung cancer, and a physician may order a CT scan if you have a history of smoking.

Vonetta Mcgee Cause Of Death, Articles S