Persistent dry cough and fever
A 3-year-old child was evaluated at ED after onset of fever and dry cough not responsive to 2 weeks of antibiotic l therapy.
On arrival, oxygen saturation was 97% and the results of physical examination were noncontributory. A posteroanterior chest radiograph showed a small lung consolidation in the right lower lobe. The patient was admitted to the pediatric care unit and he started empirical antibiotic therapy with ceftriaxone.
A chest ultrasound (CU) was performed and showed multiple supradiaphragmatic subpleural echogenic areas with heterogeneous texture and an ovular/rounded shape along the right midclavicular line at the fourth and fifth intercostal spaces. The echogenic areas were characterized by poor Doppler flow, showed no changes during acts of breathing, and resembled intestinal lumen.
Therefore, the patient underwent a CT scan which confirmed the diagnosis: congenital diaphragmatic hernia.
The patient in this study presented with symptoms typical of lower respiratory tract infection and chest radiography supported the clinical diagnosis. Chest ultrasound was more informative in terms of morphologic evaluation of the lesion detected by chest radiography.
CU played a key role in the clinical management of this patient. Lung ultrasound has demonstrated in this case diagnostic accuracy in the differential diagnosis of lung consolidations not inferior with respect to chest radiography.
CHEST 2017; 151(6):e127-e129