A 3½-year-old girl complained of a heavy sensation in her chest, as a cough that she had for three months worsened. She was febrile and had decreased breath sounds over the left side of her chest. A chest roentgenogram (Fig 1) showed an apparent left-tension pneumothorax, but a tube inserted through the chest wall on the left side did not improve her condition.
She was transferred to Denver Children's Hospital. Physical examination showed a healthy-appearing, acyanotic girl. Respirations were 30/min, pulse rate was 126 beats per minute, blood pressure was 88 mm Hg/Doppler, and temperature was 37.5°C. There were minimal retractions and markedly decreased breath sounds in the left hemithorax.
Admission laboratory values were as follows: white blood cell count, 3.6 × 109/L (3600/mm3), with 0.35 (35%) polymorphonuclear leukocytes, 0.10 (10%) basophils, 0.41 (41%) lymphocytes, 0.12 (12%) monocytes, and 0.02 (2%) metamyelocytes; hemoglobin, 127 g/L (12.7 g/dL);