A 20 month old girl with respiratory distressBMJ 2009; 338 doi: http://dx.doi.org/10.1136/bmj.b1216 (Published 08 April 2009) Cite this as: BMJ 2009;338:b1216
- D S Urquhart, paediatric respiratory fellow 1,
- S M Iqbal, paediatric respiratory fellow1,
- J Bowman, registrar2,
- S Suresh, staff specialist1
- 1Department of Paediatric Respiratory and Sleep Medicine, Mater Children’s Hospital, South Brisbane, QLD 4101, Australia
- 2Department of ENT, Mater Children’s Hospital
- Correspondence to: D S Urquhart
A previously well 20 month old girl presented to the emergency department with a history of fever and tachypnoea. She was accompanied by non-English speaking grandparents, and the available history was limited. She was tachycardic on arrival, with a heart rate of 168 beats a minute, as well as a raised respiratory rate of 52 breaths a minute. Widespread wheeze was audible, and she was given back to back bronchodilator therapy via a nebuliser.
She remained tachypnoeic (respiratory rate 38 breaths a minute), with increased air entry on the right side compared with the left. She was, however, free of wheeze. In view of the differential air entry, we undertook chest radiography (fig 1⇓).
1 Describe the radiographic abnormality
2 What is the most likely cause for such radiographic appearances?
3 What is the next step in the management of this child?
1 The chest radiograph shows a hyperlucent, unilaterally hyperinflated left lung and a degree of midline shift (fig 2)⇓.
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