M. Paetzel (Leipzig)  

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11 Months  

Male  

Thorax-Lung  

inflammatory or infectious  

11 month-old boy with high fever, respiratory distress, no cough.

1. X-ray on the day of admission.
2. X-ray after 14 days. However, on the 8th day of treatment, worsening of fever and cough and a child in obvious distress.  

A pathogen could not be found in this case. Also no evidence of specific and pathologically increased IgM-antibodies.

Based on imaging findings, this case demonstrates an alveolar infiltrate in the sense of a typical pneumonia (lobar pneumonia).

Under intravenous Claforan therapy, initially significant improvement, however after 8 days fever rose and cough worsened. It is considered that a secondary infection occurred, because the x-ray showed signs of a partial bronchial affection/obstruction with atelectasis, but without signs of airspace infiltrate anymore.  

<- view X-Ray 1

X-Ray 1: Frontal view: Homogeneous opacification of the left midle and lower lung zones. Slightly thickened pleura with a small left pleural effusion identified on the lateral view.




<- view X-Ray 2

X-Ray 2: Lateral view: Decreased transparency in the retrocardial space. Small left pleural effusion.






<- view X-Ray 3

X-Ray 3: Image performed after 14 days: no homogeneous opacification anymore, but clearly increased reticular densities in both upper lung zones. Small atelectasis on the right at the basal border of the upper lung zone.





<- view X-Ray 4

X-Ray 4: Image performed after 1.5 months: There is still mild bihilar prominence, most likely due to the persisting enlarged lymph nodes. Otherwise a normal chest radiograph for this age.


 

Expert's opinion  

Lobar pneumonia, atelectasis, foreign object aspiration  

N/A  

N/A  

N/A  

1. Medline:
Lichenstein R, Suggs AH, Campbell J.
Pediatric pneumonia
Emerg Med Clin North Am. 2003 May;21(2):437-51.  

Lobar pneumonia, atelectasis, foreign body aspiration, pneumonia, Lobular pneumonia, child, childhood, pediatric radiology  

M Paetzel. Lobar pneumonia without proven pathogen. PedRad [serial online] vol 3, no. 12.
URL: www.PedRad.info/?search=20031223165339