Right Lung Opacification – What is the diagnosis?

Ilechukwu GC, Kollannoor B, Abdulaziz M.
Department of Paediatrics, Whiston Hospital, Prescot, UK

Address for correspondence: Dr Maysara Abdelaziz, Consultant Paediatrician, St Helens & Knowsley NHS trust, Warrington Road, Prescot, Liverpool L35 5DR, UK. Email: Maysara.Aziz@sthk.nhs.uk


Clinical Problem:
A previously well, 7 week old baby presented to the paediatrics accident and emergency unit with a history of cough and fast breathing of one week duration associated with reduced oral intake of <50%. There was no fever. He was born in good condition at term by normal vaginal delivery with a birth weight of 2.77kg. He was unwell at 3 weeks of age and was admitted and treated with intravenous antibiotics. At that time his abdominal ultrasound (USG) was normal. On this presentation he was afebrile but in moderate respiratory distress (respiratory rate 60/min) with tracheal tug, intercostal retractions and head bobbing. Air entry was initially good on both sides but on later review was reduced on the right inframammary region. He was clinically suspected to have bronchiolitis and was started on intravenous fluids and chest x-ray was requested. Chest x-ray report showed extensive opacification of the right hemithorax with a small right pleural effusion. The right hemidiaphragm was not seen. There was suggestion of a subcarinal mass, splaying the carina with some atelectasis in the right upper lobe. The left hemithorax left hemidiaphragm were normal (Figure1). In view of the recent ultrasound scan showing normal right hemidiaphragm, congenital diaphragmatic hernia was excluded and a congenital cystic adenoid malformation was considered a likely diagnosis. A CT scan of the chest was advised (Figure 2).

What is the diagnosis? How to treat this patient?