An 11-year-old boy who emigrated from Armenia 3 years previously was seen by his pediatrician because of chronic cough, fever, pain on the left side of the chest on inspiration, and a yellow, purulent expectorant. A single episode of blood-tinged sputum was noted.
The child's medical history was remarkable for recurrent episodes of pneumonia in the previous 5 years, always presenting with the described symptoms. The patient had completed a 10-day course of antibiotic therapy 4 months before admission. There was no history of allergies, exposure to chemicals, cystic fibrosis, or contact with birds.
On admission, the patient was afebrile, alert, cooperative, and quiet and did not appear to be in acute distress.
The results of the physical examination included a symmetrical thorax with normal chest motion and unlabored respirations. However, decreased tactile and vocal fremitus was noted in the left lower chest as well as