Introduction
In the previous two issues of Breathe, the case of a 6-yr-old boy who had been admitted to the paediatric department of the University of Heraklion has been covered. After treatment, he was discharged in excellent condition.
12 months later, the boy was readmitted to the hospital for gradually increasing productive cough for 9 days and fever (up to 39.5°C) for 3 days.
He was in good condition. His blood temperature was 38°C, respiratory rate was 24 breaths·min−1, heart rate was 120 beats·min−1 and O2 saturation was 91%. On chest auscultation he had decreased breath sounds over the right lower hemithorax. Cardiac examination was normal, throat examination showed small exudates on tonsils and review of remaining systems was normal.
Chest radiograph (CXR) is shown in figure 1.
CXR
Task 1
How would you interpret this CXR?
Answer 1
The posteroanterior (left) and lateral (right) CXRs show opacification/consolidation of the right lower and middle lung lobes. There was blunting of the right costophrenic angle with small fluid collection. Right hemidiaphragm was not seen (positive “silhouette” sign).
Blood test results are shown in table 1. Chemistry lab tests were normal and blood cultures were sent.
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Task 2
What is your diagnosis?
Answer 2
Bacterial or viral pneumonia.
Due to symptoms, radiographic findings, leukocytosis with increased neutrophils, ESR and CRP the diagnosis of bacterial pneumonia was made. The patient was treated with intravenous ampicillin–sulbactam 150 mg·kg−1·day−1, oral clarithromycin (1 g·day−1) and inhaled bronchodilators. Chest auscultation revealed wet crackles which were gradually diminished to normal breath sound. Fever subsided on the 4th day. Intravenous antibiotics were given for 10 days.
Repeat lab tests are shown in table 2. Blood cultures were negative. Cold agglutinins for mycoplasma and pneumococcus antigen in the urine were negative. Stain of sputum showed increased white …
