Radiological Case of the Month

A 9-year-old boy had an acute onset of fever and cough. A chest roentgenogram was obtained (Fig 1) and hospital admission followed. The history was pertinent in that, when he was 6 months old, paroxysmal cough led to chest roentgenography (Fig 2) that showed abnormal findings. The blood cell count showed a lymphocytic predominance. A sweat chloride test and immunoglobulin and α₁-antitrypsin levels were normal. Bronchoscopy showed no abnormalities. Acid-fast and fungal studies of a specimen taken at bronchoscopy were negative. We elected to follow up the child as an outpatient with additional studies to be done if the pulmonary abnormality did not resolve. In the interim he had been lost to followup, during which time the family denied signs of respiratory or cardiac disease. Upon admission at 9 years of age, the white blood cell count was 18,000/cu mm with 80% polymorphonuclears. An intermediate-strength purified protein derivative