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Infant with rapidly progressive respiratory distress
  1. Stefano Pintaldi1,
  2. Alessia Giuseppina Servidio1,
  3. Marco Bobbo2,
  4. Daniela Chicco2,
  5. Lorenzo Calligaris2,
  6. Egidio Barbi1,2,
  7. Giorgio Cozzi2
  1. 1 University of Trieste, Trieste, Friuli-Venezia Giulia, Italy
  2. 2 Institute for Maternal and Child Health-IRCCS "Burlo Garofolo", Trieste, Italy
  1. Correspondence to Dr Stefano Pintaldi, University of Trieste, Trieste 34127, Italy; pintaldistefano{at}

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A 7-month-old girl presented to the emergency department with a 12-hour history of difficult breathing. The girl was alert but with a severe tachy-dyspnoea, chest retractions and nodding. Vital signs showed: respiratory rate 70/min, pulse rate 150/min and oxygen saturation 92% on room air. At chest auscultation, mild bilateral basal crackles were noted. Repeated albuterol inhalations, systemic steroid and oxygen administration through high flow nasal cannula were administered, but respiratory distress worsened in the next 2 hours. Capillary blood gas analysis showed: pH 7.37 pCO2 27 mm Hg, HCO3 17 mm Hg. A chest radiograph was performed (figure 1).

Figure 1

Chest X-ray shows enlargement of the cardiac silhouette with abnormal lung fields characterised by alveolar oedema, air bronchogram on the right side and left basal pleural effusion.


  1. Which is the most likely diagnosis in this patient?

    1. Bronchiolitis

    2. Acute respiratory distress syndrome

    3. Acute heart failure secondary to dilated cardiomyopathy

    4. Diabetic ketoacidosis

  2. Which test may help to …

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  • Contributors SP, AGS and GC wrote the paper. LC, MB and DC supervised the work. EB supervised the work and approved the final revision.

  • 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.

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