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Clinical manifestations are variable. It may be asymptomatic or present with mild to moderate tachypnea, wheezing, nasal flaring and retractions. In mechanically ventilated neonates the signs may be abrupt, with apnea, cyanosis, bradycardia, hypotension, decreased cardiac output, decreased breath sounds on the affected side and death if not treated urgently. Physical examination reveals thoracic asymmetry with bulging of the affected side, lateral deviation of the heartbeat and abdominal distension. (21-26)b) Arterial blood gases: The changes in their determinations are not specific and show a decrease in PaO2 and an increase in PaCo2 with a decrease in pH. (19) c) Radiological examination: Chest radiographic examination shows separation of the parietal pleura from the visceral pleura, hyperlucency on the affected side, contralateral mediastinal deviation, flattening of the diaphragm and some degree of pulmonary atelectasis. In a sudden clinical deterioration, thoracentesis confirms the diagnosis, at the same time that serves as urgent treatment. (21,27)d) Transillumination: With a fiber optic light source.