![]() ![]() Vital signs on arrival were HR of 130/min, RR of 36/min, temperature of 36.6☌, and Sp o 2 of 99% in 6-L/min oxygen. He was then transferred to our hospital for further management. Even after tracheal intubation and manual ventilation, his respiratory condition did not improve. He was taken to a nearby ED where he was urgently intubated. His respiratory condition improved dramatically, and he was able to be extubated on the same day.Ī 2-year-old previously healthy boy presented with a week-long history of mild cough and wheeze followed by a rapid progression to severe dyspnea. Suctioning was carried out and resulted in the removal of the whole cast (Fig. (Fig.2C) 2C) was found in the left mainstem bronchus. The presence of a bronchial cast was suspected, and flexible bronchoscopy was performed. His condition initially improved after tracheal intubation but then worsened on day 3. Chest CT was obtained after tracheal intubation and showed total atelectasis of the left lung (Fig. Although the Sp o 2 improved to 91% to 94%, his respiratory distress did not improve, and he was intubated 12 hours after arrival. He was admitted to the intensive care unit and started on high-flow nasal oxygen. No pleural effusion was detected with chest ultrasound. Disruption of air was noted in the left mainstem bronchus, and the mediastinum was deviated to the left (Fig. Chest radiograph showed unilateral whiteout of the left lung with hyperinflation of the right lung. Venous blood gas showed metabolic acidosis but no hypercapnia (pH, 7.348 P co 2, 39.5 mm Hg HCO 3 −, 21.1 mmol/L, and lactate, 3.5 mmol/L). Chest wall motion and breath sounds were both decreased on the left side. Vital signs on arrival were HR of 178/min, RR of 42/min, temperature of 39☌, and Sp o 2 of 85% in room air. His parents were both current smokers, and his mother had a history of asthma. History was remarkable for several episodes of wheezing, but he had never been given a diagnosis of or treated for asthma. He had rhinorrhea and a wet cough for several days. Streptococcus pneumoniae was detected in both the blood and pleural fluid cultures.Ī 2-year-old boy came to the ED with a chief complaint of dyspnea. A massive amount of purulent fluid was obtained. The patient was intubated, and a left-sided chest tube was inserted. Chest ultrasound and computed tomography (CT) scan revealed a large collection of pleural fluid surrounding the left lung (Fig. The mediastinum was deviated to the right (Fig. Chest radiograph showed unilateral whiteout of the left lung with an air bronchogram. There was significant elevation of inflammatory markers (white blood cells, 45,100/μL C-reactive protein 24.6 mg/dL). ![]() Auscultation of the chest revealed decreased air entry and dullness to percussion on the left side. Chest wall motion was decreased on the left side, and subcostal retractions were observed. Vital signs on arrival were heart rate (HR) of 170/min, respiratory rate (RR) of 68/min, temperature of 39.1☌, and Sp o 2 of 84% in room air. He had not received antipneumococcal vaccine. A 1-year-old boy who had been previously healthy came to the emergency department (ED) because of high fever and loss of appetite. ![]()
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