Intended for healthcare professionals

Endgames Picture quiz

A 20 month old girl with respiratory distress

BMJ 2009; 338 doi: (Published 08 April 2009) Cite this as: BMJ 2009;338:b1216
  1. D S Urquhart, paediatric respiratory fellow 1,
  2. S M Iqbal, paediatric respiratory fellow1,
  3. J Bowman, registrar2,
  4. S Suresh, staff specialist1
  1. 1Department of Paediatric Respiratory and Sleep Medicine, Mater Children’s Hospital, South Brisbane, QLD 4101, Australia
  2. 2Department of ENT, Mater Children’s Hospital
  1. Correspondence to: D S Urquhart donurquhart72{at}

    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).

    Fig 1 Chest radiograph of 20 month old girl with respiratory distress


    • 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?


    Short answers

    • 1 The chest radiograph shows a hyperlucent, unilaterally hyperinflated left lung and a degree of midline shift (fig 2).

    Fig 2 Chest radiograph of 20 …

    View Full Text

    Log in

    Log in through your institution


    * For online subscription