Page 1 / Case
Marielena DiBartolo
PGY5, Pediatric Respiratory Medicine
University of Calgary
"Cross-Canada Rounds Presentation."
A 13 year-old boy presented to the Emergency room complaining of sore throat, hoarse voice and shortness of breath. He was well until 6 weeks prior to presentation when he developed upper respiratory-like symptoms with sore throat and fever, while on vacation in Mexico. Over the course of the next 6 weeks, he began to complain of a sensation of "throat tightness" and worsening shortness of breath. The shortness of breath initially occurred with exertion, but by the time of presentation, was also present at rest, and associated with 2-pillow orthopnea as well as stridor. Other symptoms during this time included mild fatigue and 5-lbs. of weight loss.
Prior to presentation to the emergency department, his family physician had performed a mononucleosis spot test, which was negative. He had been treated with a ten-day course of clarithromycin with no improvement. He had also been treated with a 2-week course of Advair (fluticasone plus salmeterol) 125mcg Diskus, 1 puff BID, followed by salmeterol for 3 days prior to presentation, also with no improvement in symptoms. A visit to the emergency department 2 weeks prior to admission again showed a negative mononucleosis spot test.
A chest x-ray was ordered
Next page /
PRESENTING FELLOW
Marielena DiBartolo
PGY5, Pediatric Respiratory Medicine
University of Calgary
CASE PRESENTATION
"Cross-Canada Rounds Presentation."
HISTORY
A 13 year-old boy presented to the Emergency room complaining of sore throat, hoarse voice and shortness of breath. He was well until 6 weeks prior to presentation when he developed upper respiratory-like symptoms with sore throat and fever, while on vacation in Mexico. Over the course of the next 6 weeks, he began to complain of a sensation of "throat tightness" and worsening shortness of breath. The shortness of breath initially occurred with exertion, but by the time of presentation, was also present at rest, and associated with 2-pillow orthopnea as well as stridor. Other symptoms during this time included mild fatigue and 5-lbs. of weight loss.
Prior to presentation to the emergency department, his family physician had performed a mononucleosis spot test, which was negative. He had been treated with a ten-day course of clarithromycin with no improvement. He had also been treated with a 2-week course of Advair (fluticasone plus salmeterol) 125mcg Diskus, 1 puff BID, followed by salmeterol for 3 days prior to presentation, also with no improvement in symptoms. A visit to the emergency department 2 weeks prior to admission again showed a negative mononucleosis spot test.
A chest x-ray was ordered
 Figure 1a |
 Figure 1b |
PLEASE DESCRIBE THE CHEST X-RAY?
Next page /