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- Catherine Kier, MD*
- Rula Balluz, MD*
- Vikash Modi, MD†
- Latha Chandran, MD, MPH§
- *Department of Pediatrics, Stony Brook University Medical Center, Stony Brook, NY.
- †Department of Otorhinolaryngology, Weill Cornell Medical College, New York, NY.
- §Office of the Dean, Stony Brook University School of Medicine, Stony Brook, NY.
-
Author Disclosure
Drs Kier, Balluz, Modi, and Chandran have disclosed no financial relationships relevant to this case. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device
Case 1 Presentation: Persistent Pulmonary Infiltrate
A 2-year-old boy has had several hospitalizations for right upper lobe (RUL) pneumonia associated with reactive airway disease. During this episode, he presents with a low-grade fever, cough, wheezing, and an oxygen saturation of 90% to 91% on room air. His temperature is 37.9°C (axillary), respiratory rate is 38 breaths/min, heart rate is 129 beats/min, and blood pressure is 92/60 mm Hg. Posteroanterior and lateral radiographic views of the chest obtained in the emergency department (ED) show a density in the RUL area (Fig. 1). On admission, he is given intravenous hydration, intravenous ceftriaxone, albuterol nebulizer treatments, oral corticosteroids, and supplemental oxygen.
Chest radiograph taken on day 1 of admission showing a right upper lobe density.
Within 24 hours, the patient responds with improved work of breathing and resolution of hypoxia and fever. A follow-up radiograph shows persistence of the right upper lobe infiltrate. Initial and repeat blood cultures are negative. The patient is discharged after 6 days on a 10-day course of oral antibiotics, with a 2-week follow-up evaluation scheduled.
Two weeks later, the patient has improved further and does not have fever, tachypnea, or respiratory distress. Due to the recurrent nature of the RUL infiltrate, a chest radiograph is repeated to document radiologic resolution of the pneumonia. Surprisingly, the chest radiograph shows a persistent RUL density and mediastinal shift to the right (Fig. 2). Subsequent computed tomography (CT) scan of the chest reveals the underlying diagnosis.
Chest radiograph taken 2 weeks later showing persistent right upper lobe density, with right mediastinal and tracheal shift.
Case 2 Presentation: Persistent Hypoxemia
A 5-month-old female infant is admitted for an acute episode of reactive airway …
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