Welcome to Cross-Canada Paediatric - Respiratory Residency Rounds
Page 1 / Case 02.03


Dr. Muireann Ni Chroinin
Montreal Children's Hospital


An abnormal radiograph in a 10-year-old boy with a 9-week history of malaise, fever and weight loss.


A 10-year-old boy is brought to the emergency department by both parents in December 2002. He has been unwell for over two months. He no longer has any energy and doesn't play football with his friends any more. He is not eating and his parents feel that he has lost weight of 1.5 kg. He has had fevers of up to 38.5°C documented twice or three times a week and has night sweats.

His symptoms began two months previously in October 2002 when he attended his local hospital presenting with wheeze and dyspnea of acute onset. He improved with salbutamol and was diagnosed with "asthma". He was discharged on salbutamol and fluticasone propionate (250(g/day) via a metered dose inhaler and spacer (Aerochamber). His parents have not supervised his salbutamol usage since it was commenced but report that he has taken it intermittently for wheezing. He also has a four-day history of cough.

Past Medical History
In his background history he was born by elective caesarian section for breech at term. He had infectious mononucleosis in 1996 but has otherwise been well.

He was pale and thin but did not look sick. His height is on the 25th centile and his weight is on the 3rd centile. His respiratory rate was 24, oxygen saturation was 98 % in room air, pulse was 90/min and temperature was 37.7°C. There was no digital clubbing. His chest was clear on auscultation. The remainder of his examination was unremarkable.

The following chest radiograph was taken in October 2002 in his local hospital when he was seen there for "asthma".

ENLARGE the chest X-ray



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