Case of the Month

Our Imaging Case of the Month is presented as a part of the Imaging Department's residency teaching program. Each month a resident collaborates with one of our attending imaging physicians to present an interesting case to the Cedars-Sinai medical community. The case is used to teach both imaging and other residents at Cedars-Sinai. Below is the current Case of the Month.

Thomas J. Learch, MD

Respiratory Distress

Submitted by Jordan Gutovich, MD, and Thomas J. Learch, MD.

An 11-month-old boy presented to an urgent care clinic for respiratory distress, fussiness and lethargy. His vital signs were significant for a slight fever of 100.6 F. He was treated with nebulizer treatments of albuterol and sent home with a prescription for amoxicillin. After several days, his symptoms did not improve and he presented to the emergency department. A chest radiograph was obtained that demonstrated a large consolidation in his left lung (Figure 1). He was treated for pneumonia with IV ceftriaxone and discharged home with a prescription of oral Cefdinir. After several weeks, the patient continued to exhibit increased work of breathing, fussiness and nasal flare. A follow up chest radiograph demonstrated a persistent large consolidation in the left lung (Figure 2).

A CT of the chest was obtained that revealed a large left congenital diaphragmatic hernia with a large amount of abdominal contents in the the thoracic cavity (Figures 3 and 4). The patient was taken to the operating room and underwent a thoracoscopic repair of the left congenital diaphragmatic hernia that was of the Bochdalek subtype. A follow-up postoperative chest radiograph demonstrated a large left pneumothorax and a hypoplastic left lung (Figure 5).

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