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A pneumonia that does not improve
  1. Samuele Naviglio1,
  2. Matteo Chinello1,
  3. Alessandro Ventura1,2
  1. 1University of Trieste, Trieste, Italy
  2. 2Institute for Maternal and Child Health IRCCS “Burlo Garofolo”, Trieste, Italy
  1. Correspondence to Dr Samuele Naviglio, University of Trieste, via dell'Istria 65/1, Trieste 34137, Italy; samuele.naviglio{at}gmail.com

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A 2-year-old, previously healthy child was admitted for fever, cough and tachypnoea with intercostal and suprasternal retractions. Crackles and diminished breath sounds were noted on the left hemithorax. Peripheral oxygen saturation (SpO2) was 85% while breathing ambient air. Antibiotic therapy and oxygen supplementation were started for presumed bacterial pneumonia. Despite prompt resolution of fever and improvement of general conditions, after 5 days SpO2 remained 90%, rising to 99% with oxygen supplementation. Physical examination demonstrated markedly diminished breath sounds on the left hemithorax. A chest radiography was performed (figure 1).

Figure 1

Chest radiograph.

Questions

  1. What conditions should be considered when a child with suspected community-acquired pneumonia does not improve as expected with antibiotic therapy?

  2. What does the chest X-ray show?

  3. Which diagnosis does the X-ray coupled with history and physical examination suggest?

  4. What should be …

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