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Picture of the Month Quiz

An 8-year-old boy from Botswana was referred to a tertiary-level center with a 1-day history of fever, dry cough, headache, shortness of breath, and chest pain. One month prior, he had a similar episode and was treated for a left-sided pneumonia. He was otherwise healthy; human immunodeficiency virus testing results were negative.

On admission, the child was ill-appearing, febrile (38.9°C), tachypneic, and hypoxic. A pulmonary examination revealed mild subcostal retractions and decreased air entry in the left lower zone with dullness on percussion. Chest radiography (Figure 1) showed an encapsulated structure in the left lower zone with an air-fluid level. Abdominal computed tomographic scan detected a single well-defined cyst in the right lobe of the liver. On day 3 of admission, he developed acute respiratory distress. Examination showed tracheal deviation to the right with resonance and absent breath sounds over the left lung field. A repeated chest radiograph (Figure 2) revealed a left-sided tension pneumothorax.

Image of chest radiography

Figure 1.

Image of a repeated chest radiograph

Figure 2.

What is your diagnosis?

For a complete discussion of this month's case, read next month's Picture of the Month—Quiz Case. For a complete discussion of last month's case, read this month's Picture of the Month—Quiz Case.