A 14-MONTH-OLD girl was seen in the pediatric emergency department with a 1-month history of difficulty breathing, clear rhinorrhea, cough, and fever. Five months before admission, she had undergone antibiotic treatment for pneumonia diagnosed by chest radiography (Figure 1). During the month preceding this admission, she had been seen by her physician on 3 different occasions and treated with β-agonists, steroids, and antibiotics. On the day of admission, the patient was seen by her pediatrician because of continuing symptoms of respiratory distress. She was tachypneic and because no improvement in her condition was noted with β-agonist administration via nebulizer, she was referred to a local hospital where findings on chest radiographs were interpreted as a left pneumothorax (Figure 2). A chest tube was placed in her left hemithorax, but no air release or resolution of symptoms occurred. The patient was transferred for further evaluation and therapy.
In the emergency department,