Bronchiolitis: an infant with a dry cough

Abstract

A 25 week old boy with a week’s history of worsening chest infection was brought to the paediatric emergency department by his parents. He had a dry cough and was short of breath and wheezing. His mother had noticed less milk intake, more vomiting after feeds, and subsequent weight loss (from the ninth to the 0.4th centile in two weeks). His general practitioner had prescribed salbutamol inhaler and amoxicillin antibiotics, but symptoms had worsened over the next two days. The infant was born at 36 weeks by emergency caesarean section. He needed resuscitation with bag and mask for two minutes and was admitted to the neonatal intensive care unit because of respiratory distress. He developed pneumonia at four weeks and pyloric stenosis, for which he underwent a pyloromyotomy at seven weeks. There were no known family congenital defects or consanguinity. Respiratory examination showed subcostal and intercostals recession and decreased air entry bilaterally, with expiratory wheeze. (1) What are the differential diagnoses for shortness of breath in an infant? (2) What are the radiological findings …