A 19-MONTH-OLD boy had a 2-day history of intermittent cough, mild fever, and decreased appetite. Six hours prior to evaluation, the patient had had a coughing episode during which he became cyanotic while eating a piece of orange. On physical examination, he was comfortable, well nourished, and free of respiratory distress. Both tympanic membranes were erythematous. Air entry in both lungs was the same, but respiratory crackles were heard in the left lower lobe. Initial oxygen saturation was 88% on room air and 96% on 1.5 L/min of oxygen. An anteroposterior inspiratory chest radiograph was obtained (Figure 1). He was admitted to the hospital and treated with oral erythromycin and sulfisoxazole, nebulized albuterol, and oxygen. Two days later, he had another paroxysmal coughing episode with cyanosis, and a second chest radiograph was obtained (Figure 2).
Ozdemir A, Cosentino CM, Siwik SA, Wilfond BS. Radiological Case of the Month. Arch Pediatr Adolesc Med. 1998;152(9):921-922. doi:10.1001/archpedi.152.9.921