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Child presenting with breathlessness 1 month after cardiac surgery
  1. Valentina Gesuete1,
  2. Simona Salis2,
  3. Giulia Gortani3,
  4. Egidio Barbi2,3
  1. 1 Cardiology Service, Institute for Maternal and Child Health - IRCCS ’Burlo Garofolo' - Trieste, Trieste, Italy
  2. 2 School of Medicine, University of Trieste, Trieste, Italy
  3. 3 Pediatric Emergency Department, Institute for Maternal and Child Health - IRCCS ’Burlo Garofolo' - Trieste, Trieste, Italy
  1. Correspondence to Dr Valentina Gesuete, Cardiology Service, IRCCS materno infantile Burlo Garofolo, Trieste 34137, Italy; valegesuete{at}gmail.com

https://doi.org/10.1136/archdischild-2018-316156

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    A 2-year-old female child was referred to the emergency department for fever and dyspnoea. Her history was remarkable for a cardiac surgery 1 month before to correct a sinus venosus atrial septal defect, pulmonary valve stenosis, partial anomalous pulmonary venous return (right pulmonary veins) and persistent left superior vena cava (SVC) draining into the coronary sinus. The child had been discharged on furosemide therapy. The therapy had been suspended two days before access to the emergency room. Physical examination showed a suffering and dyspnoeic child with a venous reticulum on the chest and eyelid oedema. On lung auscultation, vesicular sound was absent on the right thorax. Oxygen saturation was 94%. A chest X-ray was performed (figure 1).

    Figure 1

    The chest X-ray showed a complete opacification of the right hemithorax with mediastinal shift to the left.

    QUESTIONS

    1. What is your diagnosis?

    1. Atelectasis.

    2. Pneumothorax.

    3. Right pleural effusion.

    4. Pneumonia.

    2. Considering the result of the chest …

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    Footnotes

    • Contributors Each author listed on the manuscript has seen and approved the submission of this version of the manuscript and takes full responsibility for the manuscript. VG: project development, data collection and management, manuscript writing. SS: data collection. GG: data collection. EB: project development, manuscript editing.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; internally peer reviewed.