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Image challenge
Wheezing for weeks: respiratory distress in an infant
  1. Rebecca Wiersma1,
  2. Rahul Kaila2
  1. 1 Pediatrics, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
  2. 2 Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Rebecca Wiersma, Pediatrics, University of Minnesota Twin Cities, Minneapolis, MN 55454, USA; wiers061{at}umn.edu

http://dx.doi.org/10.1136/emermed-2021-212097

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    Clinical introduction

    A previously healthy infant presented to the ED with 1 day of respiratory distress following 2 weeks of wheezing. Review of systems was negative for cough, congestion, fever and difficulty feeding. He had subcostal and intercostal retractions, grunting, shallow chest rise, tachypnoea (RR 70–80), HR of 157, BP 127/100 and normal temperature. He became lethargic, tachycardic (230) and BP dropped to 74/35. Left needle decompression was attempted without air return. BP and HR improved, but the patient remained tachypnoeic. CXR was performed (figure 1).

    Figure 1

    Initial CXR.

    Question

    Based on history and imaging findings, what is the diagnosis in this …

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    Footnotes

    • Contributors RW was the primary author, who obtained images and submitted the final manuscript. RK edited and submitted the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.