Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
The patient was a 2 and 1/2 year old female with respiratory distress. A chest film diagnosed pneumonia. Blood cultures grew out pneumococcus. She developed a left sided effusion that became an empyema.
Clinical Physical Exam:
Blood culture positive for pneumococcus
Clinical Differential Diagnosis:
AP chest film from the first hospital day showed a left lower lobe infiltrate. AP chest film from the 8th hospital day suggested a developing cavity in the left lower lobe. Enhanced chest CT exam on the 8th hospital day revealed a cystic lesion forming in the left lower lobe, along with extensive infiltrate and atelectasis and effusion. Repeat enhanced chest CT exam on the 21st hospital day demonstrated enlargement and progression of the left lower lobe lesion and a left sided tension pneumothorax.
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Images 5 and 6
Imaging Differential Diagnosis:
Pneumatocele / Tension Pneumothorax secondary to rupture of pneumatocele.
The patient continued to have a rocky clinical course, remaining febrile on IV antibiotics and then on PO antibiotics after discharge. Two months after the initial presentation the patient was taken to the operating room and the pneumatocele was drained of air and a small amount of fluid.
The fluid, when cultured, grew out Moraxella catarrhalis.
Pneumatocele, Post Bacterial Infection / Pneumothorax, Tension
Follow-up and Prognosis:
The patient remained afebrile and recovered after given antibiotics to cover Moraxella catarrhalis.
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