Figure 1:

CXR completed on day 5 of admission demonstrates right perihilar and lower lobe opacities.

Welcome to this Contemporary Pediatrics poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then, visit our website on July 23, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Umer Muhammad, MD;Neil Copeland, MD; and John Bishara, DO.

The case:

A 23-month-old female presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (Figure 1).

On physical examination, the patient showed signs of respiratory distress. A chest X-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital.

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes.

Below, take your best guess at diagnosing this patient.

Visit the Contemporary Pediatrics website on Wednesday July 23 at 3:00 pm EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

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