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J R Soc Med. 2002 November; 95(11): 560.
PMCID: PMC1279259

Cough and tachypnoea in a toddler

A previously well 17-month-old girl of Caucasian origin was taken to her local hospital after 24 hours of cough and increasing difficulty with breathing. She was pyrexial (39°C), tachycardic (170 min-1) and had a slightly increased capillary return time. She was also tachypnoeic with grunting. Breath sounds were diminished on the right. Pulse oximetry showed oxygen saturations of 95%. Cardiac auscultation was normal. The presumptive diagnosis was lower respiratory tract infection and she was started on broad-spectrum antibiotics. A chest X-ray showed two or three air—fluid cavities in the right hemithorax (Figure 1). Within 2 hours of admission her respiratory status deteriorated greatly and she was electively ventilated after rapid-sequence intubation. A post-intubation chest X-ray, primarily performed to check the position of the endotracheal tube, unexpectedly revealed an increase in the size and number of cavities in the right hemithorax (Figure 2).

Figure 1
Chest radiograph on admission
Figure 2
Chest radiograph after intubation


What was the diagnosis? Send your answer to the Editor by 20 December. A prize, Martin Howard's Wellington's Doctors (reviewed on p. 569) will be awarded for the first correct entry drawn from a hat. The outcome of the case, the name of the winner, and the names of those who made the diagnosis or something close to it, will be reported in the February 2003 JRSM.

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press