Clinical History.—A 2-month-old girl was admitted to the hospital because of cough and labored respirations. There had been no respiratory difficulties in the newborn period. During the previous ten days, the mother had noted intermittent but persistent coughing associated with progressive difficulty in breathing.
Physical Examination.—The rectal temperature was 37.8 C (100 F) and the respiratory rate was 48/min. Breath sounds were absent over the anterior and posterior aspects of the upper right side of the chest. Results of the remainder of the physical examination were within normal limits.
White blood cell count was 20,200/cu mm with 86% polymorphonuclear leukocytes. Hemoglobin, electrolyte, and blood urea nitrogen levels were normal, along with results of urinalysis. A chest roentgenogram taken on admission demonstrated a large soft tissue mass density with mediastinal displacement to the left (Fig 1). An esophagram was normal.
Following five days of antibiotic therapy without clinical