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Rattlin’ in the chest: Community-acquired pneumonia
Case presentation
A 7-year-old male with a medical history of asthma presents with 7 days of cough and “not feeling well.” Four days ago, the patient developed fever to 103 degrees Fahrenheit. He was seen at his primary care provider 2 days ago and started on azithromycin, but he has not been eating or drinking well for the past several days and has had decreased urine output. He has complained of difficulty breathing today despite albuterol use, prompting the evaluation in the Emergency Department. He has not had emesis, diarrhea, or abdominal pain. Physical examination reveals a temperature of 103 degrees Fahrenheit, heart rate of 120 beats per minute, respiratory rate of 25 breaths per minute, blood pressure of 100/60 mm Hg, and an oxygen saturation of 94% on room air. He has mildly dry mucous membranes. His pulmonary examination reveals crackles and diminished breath sounds in the right upper lobe.
Imaging considerations
Imaging is frequently utilized in the evaluation of children with respiratory symptoms. The initial differential diagnosis is broad, with history and physical examination serving to narrow the differential diagnosis and assist the clinician in choice of imaging, if clinically indicated.
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