CLINICAL HISTORY.—This 6-week-old boy, previously healthy, was admitted to Childrens Hospital of Los Angeles with a history of a cough for four days and fever for one day. The cough was progressive and increasingly severe. On the day of admission, the child became anorexic, febrile, and dyspneic, and circumoral cyanosis was noted. He vomited twice following feedings and had one small, loose, green stool.
Physical Examination.—The patient's temperature was 101.4 F (38.6 C); pulse rate, 140 to 160 beats per minute and irregular; and respiratory rate, 40 to 60 breaths per minute. The right tympanic membrane was obscured by clear, watery fluid, and the left was dull, gray, erythematous, and retracted. There were marked intercostal and substernal retractions, and rales were heard in the base of the right lung. The abdomen was protuberant, and a mass, thought to be the liver, was palpable 5 cm below the right costal