Case 3: Respiratory Distress in a 3-Month-Old Boy

Abstract

1. Nancy Tran, BA* 2. Harold S. Bernstein, MD, PhD† 3. Michael D. Cabana, MD, MPH‡ 1. *University of Vermont College of Medicine, Burlington, VT. 2. †Mindich Child Health and Development Institute, Icahn School of Medicine at Mount Sinai, New York, NY. 3. ‡Departments of Pediatrics, University of California San Francisco, San Francisco, CA. A 3-month-old boy whose parents say that he has been “breathing hard” for 1 day presents to the urgent care clinic. According to his parents, there is no history of fever, cough, or symptoms with feeding. Medical history includes a normal spontaneous vaginal delivery at 39 weeks. Immunizations are up to date. There are no sick contacts. His vital signs are as follows: temperature, 98.2°F (36.8°C); pulse, 168 beats per minute; respiratory rate, 70 breaths per minute; oxygen saturation in the right upper extremity is 100% in room air; and blood pressure was not obtained. Head circumference and length are in the 50th percentile, and weight is at the 25th percentile. On examination, he is well-appearing with adequate perfusion. Lungs are clear to auscultation. Pulses are good in all extremities. Abdomen is soft with a normal liver span. Cardiac examination reveals a hyperdynamic precordium with a rapid heart rate; normal S2 and splitting of S2 could not be heard because of the rapid heart rate. No murmurs or extra sounds are heard. Chest radiography reveals normal cardiothymic silhouette with an ill-defined, hazy opacification within the bilateral bases with obscuration of the right heart border and another opacification of the retrocardiac …