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February 1988

Radiological Case of the Month

Author Affiliations

Contributed from the Departments of Pediatric Pulmonology (Drs Fan and Stenmark), Radiology (Drs Strain and Foley), and Surgery (Dr Bailey), Denver Children's Hospital; and the Departments of Pediatrics (Drs Fan and Stenmark), Radiology (Drs Strain and Foley), and Surgery (Dr Bailey), University of Colorado School of Medicine, Denver.

Am J Dis Child. 1988;142(2):189-190. doi:10.1001/archpedi.1988.02150020091037

A 3½-year-old girl complained of a heavy sensation in her chest, as a cough that she had for three months worsened. She was febrile and had decreased breath sounds over the left side of her chest. A chest roentgenogram (Fig 1) showed an apparent left-tension pneumothorax, but a tube inserted through the chest wall on the left side did not improve her condition.

She was transferred to Denver Children's Hospital. Physical examination showed a healthy-appearing, acyanotic girl. Respirations were 30/min, pulse rate was 126 beats per minute, blood pressure was 88 mm Hg/Doppler, and temperature was 37.5°C. There were minimal retractions and markedly decreased breath sounds in the left hemithorax.

Admission laboratory values were as follows: white blood cell count, 3.6 × 109/L (3600/mm3), with 0.35 (35%) polymorphonuclear leukocytes, 0.10 (10%) basophils, 0.41 (41%) lymphocytes, 0.12 (12%) monocytes, and 0.02 (2%) metamyelocytes; hemoglobin, 127 g/L (12.7 g/dL);

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