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Special Feature
Sep 2011

Picture of the Month—Quiz Case

Author Affiliations


Author Affiliations: Division of Emergency Medicine (Drs Burghardt, Neuman, Capraro, and Nagler) and Department of Otolaryngology (Dr Volk), Children's Hospital Boston, Boston, Massachusetts.

Arch Pediatr Adolesc Med. 2011;165(9):865. doi:10.1001/archpediatrics.2011.141-a

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).

Image not available

Figure 1. Chest radiograph demonstrates pneumomediastinum with subcutaneous emphysema. Additionally, there is near-complete collapse of the left lung with associated leftward mediastinal shift.

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