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A 13-year-old girl presented with a 3-day history of worsening paroxysmal cough and vomiting. She also described chest pain over the preceding 3 weeks. These acute symptoms occurred on a background of cough, dyspnoea and weight loss over a 2-month period. She had no significant past medical history. On examination, she was afebrile, pale and lethargic. Her respiratory rate was 22 breaths/min , oxygen saturations were 91% in room air and heart rate was 88 beats/min. Air entry was good throughout and there was no wheeze on auscultation. A chest X-ray performed 1 month previously was normal. A repeat chest X-ray was requested (figure 1).
What abnormalities are visible on the chest X-ray?
What is the most likely diagnosis?
Gastro-oesophageal reflux disease
Metabolic bone disease …
Contributors All authors contributed equally to the manuscript.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.