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Epilogue
Unusual cause of hypoxia
  1. Aoife Ryan1,
  2. Anne Devenny1,
  3. Timothy John Bradnock2,
  4. Atul Sabharwal2,
  5. Seamus Culshaw3,
  6. Greg Irwin3,
  7. Ross John Langley1,4
  1. 1 Department of Paediatric Respiratory & Sleep Medicine, Royal Hospital for Children, Glasgow, UK
  2. 2 Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK
  3. 3 Department of Paediatric Radiology, Royal Hospital for Children, Glasgow, UK
  4. 4 Department of Maternal and Child Health, University of Glasgow, Glasgow, UK
  1. Correspondence to Dr Aoife Ryan; aoife.ryan2{at}nhs.scot

https://doi.org/10.1136/archdischild-2023-326480

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    A 7-year-old boy was referred to a tertiary centre for further assessment having been found to be hypoxic (SpO2 83% in air) during GP consultation where he presented with a 3-day history of non-productive cough. He was afebrile. Previously fit and healthy, he played regular football with no reported exertional dyspnoea. There was no significant family history.

    On examination he had mild finger clubbing but no evidence of cyanosis or respiratory distress. There were no visible mucocutaneous stigmata. His chest was clear on auscultation. Normal heart sounds were heard with no audible murmurs. Neurological examination was normal. Blood investigations demonstrated a normal capillary blood gas, an elevated haemoglobin (162 g/L) and haematocrit (0.462 l/l), and a low C-reactive protein (<1 mg/L).

    A plain film chest radiograph was performed on admission (figure 1) depicting an area of focal left upper zone reticulation (indicated via red arrow). Initially, there was concern that this could represent underlying bronchiectasis, prompting performance of a non-contrast …

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    Footnotes

    • Contributors RJL conceived the idea for this epilogue. AR drafted the initial manuscript. RJL and AD provided comprehensive review and editorial. SC and GI provided radiographic images and accompanying commentary. All authors contributed to this patient’s care.

    • 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.