Diagnostic Dilemma

Grunting


Author:
Question
A 4 months old boy presented with cough for 5 days, fever for 2 days and breathlessness for 1 day associated with refusal of feeds and irritability. There is no altered sensorium or vomiting. On looking at the child, the child is very irritable, has bilateral alae nasi flaring, has a respiratory rate of 38/min with grunting, paradoxical respiration and a prolonged inspiratory time.

Does the child have bronchiolitis, bronchitis or pneumonia?
Expert Opinion :
This child has presented at an age where bronchiolitis and pneumonia are common. Bronchiolitis usually presents as a viral prodrome of cough and cold followed by breathlessness. Fever is not a marked feature. Also the chest will be hyperinflated, child will have tachypnea and will be hypoxic as well as have rhonchi. Pneumonia is usually accompanied by fever. With pneumonia, the pathology is in the alveoli. Hence oxygenation is a problem. Carbon dioxide washout is not a problem. Carbon dioxide retention occurs in pathology of the airways which leads to prolonged and active expiration. Thus, in this child since child is irritable, has inspiratory time prolonged, oxygenation is a problem. Now, the child seems to have severe hypoxia with impending respiratory failure as he has already got flaring of alae nasi, paradoxical respiration and grunting, such severe hypoxia is seen with a severe parenchymal lung disease and which suggests a diagnosis of severe pneumonia. On auscultation, there were bilateral bronchial breathing and crepts and chest X-Ray showed bilateral necrotizing pneumonia. The child required 60% FiO2 and IV antibiotics to which his pneumonia and hypoxia were controlled.
Answer Discussion :
M
mohamed mustafa
bubble
Bronchialiyis
3 months ago
M
Mona Samaha
bubble
bronchiolitis
3 months ago

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