Clinical History.—A 9-year-old boy was admitted to the hospital because of a one-year history of chronic cough, recurrent fever, intermittent wheezing, and weight loss. The cough was exacerbated during nighttime sleep. He had been treated unsuccessfully with several courses of antibiotics. Complete evaluation by an allergist and otolaryngologist were normal.
On physical examination, the patient was below the third percentile for both height and weight. He appeared chronically ill but was in no acute distress. Vital signs were normal. Rales were heard posteriorly at the lung bases, but the remainder of the physical examination was within normal limits.
White blood cell count was 17,000/cu mm, with 67% polymorphonuclear leukocytes (60 segmented neutrophils and seven band forms). Hemoglobin, electrolytes, and BUN levels, and results of urinalysis, blood gas analysis, blood cultures, and tuberculin skin tests were all normal. Posteroanterior (Fig 1, top) and lateral (Fig 1, bottom) chest roentgenograms were obtained.
Young LW, Maravilla AM, Barnes JC, Kirks DR. Radiological Case of the Month. Am J Dis Child. 1979;133(8):855–856. doi:10.1001/archpedi.1979.02130080095021
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