Welcome to Cross-Canada Paediatric - Respiratory Residency Rounds
Page 1 / January 08


Tareq Al-Abdoulsalam
from the Montreal Children's Hospital


Today I will present a patient that we have seen in our emergency department (ED) two months ago. The ED consult said "Shortness of breath with right pleural effusion, please assess!".

The patient was a seventeen-year old Caucasian girl with trisomy 21 and hypothyroidism, who presented to the ER with five-day history of dyspnea, two-pillow orthopnea, productive cough, chest pain during coughing bouts, and right shoulder pain. Apart from controlled hypothyroidism, the patient did not have any other chronic medical problem. There were no known allergies. The patient was on thyroxin, oral contraceptive pills, and Nasal fluticasone spray. Her father had hypercholesterolemia and otherwise the family history was negative for cardiac or respiratory diseases.

On physical examination she was talkative, not in severe respiratory distress and just had mild nasal flaring. She was afebrile, although she spiked fever on that night and was not tachypnic. Her heart rate and blood pressure were stable. Her SaO2 was 96% on room air. Her chest examination revealed no retractions, but decreased air entry in the right hemi-thorax with dullness to percussion. The rest of the exam was unremarkable. She had a chest radiograph.

Figure 1 Figure 2

Please comment on the chest radiograph

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