Pediatric Case Study: 10-Year-Old Boy with Fever and Chest Heaviness
A 10-year-old boy presented with fever, left-sided chest heaviness, and respiratory distress. Examination revealed decreased air entry on the left side and dullness on percussion. Possible differentials include left-sided consolidation, pleural effusion, hydropneumothorax, and mass lesion.
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DR IMDADUL HOQUE PGT 1STYEAR PEDIATRICS,NBMCH
A 10 year old boy from coochbehar born out of non- consanguinous marriage admitted to NBMCH on 13th junewith complaints of 1. Fever for last 10 days. 2. Left sided chest heaviness for last 3 to 4 days. 3. Respiratory distress for last 3 to 4 days.
FEVER Started 10 days back Not documented Low grade intermittant in nature as described by his grandmother. Decreased with medication. Not associated with chills and rigors. Not associated with eye discharge,eardischarge ,loose motion, vomiting, burning sensation during micturation,rash,jointpain and swelling,lossof consciousness,convulsion.
Chest heaviness Started 3 to 4 days back Intermittant in nature. Not associated with any history of trauma,orthopnea,dyspnea,chestpain.
Respiratory distress Started 3 to 4 days back Mild, intermittant in nature No a/w bluish discoloration of skin,difficulty in feeding, vomiting,cough with expectoration,changes in mental status
No history of contact with TB or COVID 19. No history of trauma or foreign body aspiration. No history of pet a dog or cat.
EXAMINATION Patient is conscious, alert, interested in surroundings. Pulse rate- 96/min, vol- normal, rhythm- regular BP- 94/48 mm of Hg Temp- 99.8 degree F Spo2 -96% in room air Chest RR -32/min, no subcostal or intercostal suction, decreased air entry on left lower side of chest, no crepts or wheeze, Dull on percussion on Left Lower side of chest. PA- soft, IPS +, no organomegaly.
SUMMARY 10 year old boy Fever, chest heaviness(left side),respiratory distress Decreased air entry on left side Dull on percussion
DIFFERENTIAL DIAGNOSIS Left sided consolidation. Left sided pleural effusion. Left sided hydropneumothorax. Left sided mass lesion.
INVESTIGATIONS Hb-13.2 gm/dl TLC- 12660/mm3 N59 L32 M2 E7 B0 Platelet -643k/mm3 CRP- 1.88mg/lit Urine RE ME- WNL
XRAY Rounded opacity over left lower lobe of lung with obliteration of left costophrenic angle.
Monteux test NEGATIVE CBNAAT of gastric aspirate- no TB microorganism found
USG CHEST 7cm X 7 cm cystic SOL in posterior part of left lower lobe of lung with tri-layer coverings suggestive of hydatid cyst of stage CE1.
USG ABDOMEN NORMAL STUDY
CE1 T/T: Albendazoleonly (15mg/kg, max 800 mg/day) >5cm-PAIR (PERCUTANEOUS ASPIRATION INSTILLATION AND REASPIRATION) & Albendazole
CE2 T/T: Surgery and Albendazole therapy.
CE3 T/T: 3a:Albendazole only (15mg/kg, max 800 mg/day) >5cm-PAIR & Albendazole. 3b:Surgery and Albendazole therapy.
CE4 & CE5 (ADVANCED STAGES) Ultrasonographically followed for reactivation.
HRCT THORAX A well defined encapsulated cystic lesion noted in left side of lower lung field measuring SI- 74mm,AP-80mm. No wall calcification or intralesionalcalcification or hemorrhage seen. There is no communication of cystic lession with the bronchopulmonary tree. Mild pleural effusion in left lower lobe. Suggestive of Hydatid cyst in left lower lobe of lung.
SERUM ECHINOCOCCAL ANTIBODY 3.11(positive) by enzyme immunoassay.
WHAT TREATMENT OPTION DO WE HAVE? Stage CE1 with cyst size more than 5cm PAIR(Percutaneous,Aspiration,Instillation and Reaspiration) with Albendazole therapy.
WHAT IS BEING DONE. Given Albendazole tablet alone (15 mg per kg). Follow up being done Ultrasonographically
ON FOLLOW UP After one month, Patient is doing well. Afebrile, no respiratory distress.
USG CHEST Size 6.0 x 6.5 cm in left posterior lobe of lung. No intralesional hemorrhage or wall calcification. Stage CE1
