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Picture of the Month Quiz

Image of a portable chest radiograph
Image of removed material

Figure 1.

Figure 2.

An 11-month-old boy presented to the emergency department with a 24-hour history of barking cough and sudden onset of increased work of breathing. The family reported that his respiratory difficulty acutely worsened after a bout of forceful coughing shortly prior to arrival. On examination, the patient was ill appearing. His vital signs revealed a respiratory rate of 50 breaths/min and oxygen saturation of 76% on room air. The patient was in moderate respiratory distress, with grunting and retractions noted. There was no stridor. Auscultation of the chest revealed decreased breath sounds on the left. A portable chest radiograph was obtained (Figure 1), and subsequent bronchoscopy led to removal of the material in Figure 2.

For a complete discussion read the Picture of the Month—Quiz Case.