SECTION EDITOR: SAMIR S. SHAH, MD, MSCE
Author Affiliations: Division of Emergency Medicine (Drs Burghardt, Neuman, Capraro, and Nagler) and Department of Otolaryngology (Dr Volk), Children's Hospital Boston, Boston, Massachusetts.
An 11-month-old boy presented to the emergency department with a 24-hour history of barking cough and sudden onset of increased work of breathing. The family reported that his respiratory difficulty acutely worsened after a bout of forceful coughing shortly prior to arrival. On examination, the patient was ill appearing. His vital signs revealed a respiratory rate of 50 breaths/min and oxygen saturation of 76% on room air. The patient was in moderate respiratory distress, with grunting and retractions noted. There was no stridor. Auscultation of the chest revealed decreased breath sounds on the left. A portable chest radiograph was obtained (Figure 1).
Figure 1. Chest radiograph demonstrates pneumomediastinum with subcutaneous emphysema. Additionally, there is near-complete collapse of the left lung with associated leftward mediastinal shift.
What is your diagnosis?
Burghardt L, Neuman MI, Capraro AJ, Volk MS, Nagler J. Picture of the Month—Quiz Case. Arch Pediatr Adolesc Med. 2011;165(9):865. doi:10.1001/archpediatrics.2011.141-a