Our Answer

Bilateral peribronchial thickenings. However, there was asymmetry of the pulmonary vessels on right and left, which was unnoticed on that ER visit

The working diagnosis of the ED physician was to rule out a seizure disorder and atypical pneumonia. She was started on Azithromycin with an EEG arranged to be done as an outpatient. However, she came back to ED the next week when the pleural effusion was diagnosed.

Now back to the day of consult.

What is your differential diagnosis?

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