R. NICKBRYANMDS. JAMESZINREICHMD
A 3-YEAR-OLD African American girl presented with a 1-week history of respiratory difficulty. She had previously been admitted to an outside hospital for 72 hours with a diagnosis of bronchiolitis-vs-pneumonia, with the chest x-ray film showing a left lower lobe infiltrate. Forty-eight hours after discharge, she had a coughing episode at home and became acutely cyanotic. The emergency medical service was called, and the patient was intubated and transferred to the local hospital. She was unable to be adequately oxygenated, even with increasing ventilator settings. The mobile extracorporeal membrane oxygenation (ECMO) unit of the Arkansas Children's Hospital, Little Rock, was consulted, and the patient was placed on mobile ECMO and transferred to the hospital. A chest x-ray film demonstrated an abnormality (Figure 1, arrow), and the otolaryngology service was then consulted. Physical examination revealed a child on mechanical ventilation and ECMO with markedly decreased breath sounds bilaterally.
Hutcheson JA, Bower C. Imaging Quiz Case 2. Arch Otolaryngol Head Neck Surg. 2001;127(4):454. doi: