Wheezing for weeks: respiratory distress in an infant

Clinical introduction A previously healthy infant presented to the ED with 1 day of respiratory distress following 2 weeks of wheezing. Review of systems was negative for cough, congestion, fever and difficulty feeding. He had subcostal and intercostal retractions, grunting, shallow chest rise, tachypnoea (RR 70–80), HR of 157, BP 127/100 and normal temperature. He became lethargic, tachycardic (230) and BP dropped to 74/35. Left needle decompression was attempted without air return. BP and HR improved, but the patient remained tachypnoeic. CXR was performed (figure 1). Question Based on history and imaging findings, what is the diagnosis in this patient? Foreign body aspiration Congenital lobar emphysema Swyer-James syndrome Tension pneumothorax Answer: B CXR demonstrated left lobar overinflation with left-to-right mediastinal shift, suggestive of congenital malformation (figure 2). CT of the chest showed overinflation of the left upper lobe...
Source: Emergency Medicine Journal - Category: Emergency Medicine Authors: Tags: EMJ Image Challenge Source Type: research