Case 22

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Clinical History:
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:
Respiratory distress.

Clinical Labs:
Blood culture positive for pneumococcus

Clinical Differential Diagnosis:
Pneumonia, bacterial

Imaging Findings:
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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Imaging Differential Diagnosis:
Pneumatocele / Tension Pneumothorax secondary to rupture of pneumatocele.

Operative Findings:
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.

Pathological Findings:
The fluid, when cultured, grew out Moraxella catarrhalis.

Final Diagnosis:
Pneumatocele, Post Bacterial Infection / Pneumothorax, Tension

Follow-up and Prognosis:
The patient remained afebrile and recovered after given antibiotics to cover Moraxella catarrhalis.

Similar Cases:
Case 29

References:

• Paediapedia
• Paediapedia

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