A 5-Year-Old Girl With Fever and Cough

Nicholas J. Bennett, MB BChir, PhD

Disclosures

October 11, 2016

Physical Examination and Workup

Upon physical examination, the patient is a slightly ill-appearing young girl in no acute distress. Her temperature is 102.6°F, respiratory rate is 28 breaths/min, heart rate is 152 beats/min, and blood pressure is 103/62 mm Hg. The pulse oximetry reading is 98% while she is breathing room air. Her lungs sound clear bilaterally, with normal percussion and no areas of decreased breath sounds, rales, or wheezing.

Figure 1.

Figure 2.

Figure 3.

The patient has normal heart sounds without any murmur, a soft abdomen without organomegaly, mild cervical adenopathy, and no rashes. Her extremities are warm and well-perfused, with a capillary refill time of 2 seconds. No other lymph nodes are palpable in her axillae or groin.

Because of the recurrent fever and cough, a chest radiograph is obtained (Figure 1), which reveals a right upper-lobe opacification and an area of increased lucency. CT of the chest clarifies the diagnosis (Figures 2 and 3).

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