Notes: Treat with azole antifungal. For severe or invasive cases with amphotericin.
Question: Which organism causes these findings?
Aspiration Pneumonia
Category: generalpediatrics-Pulmonology
Findings: history of neurological disease or dysphagia, diffuse infiltrates on CXR, fever, tachypnea, cyanosis
Notes: Treat anaerobic and gram-negative organisms with antibiotics such as ampicillin-sulbactam or a combination of metronidazole and amoxicillin. You may use clindamycin in patients with penicillin allergy.
Bacterial Tracheitis
Category: generalpediatrics-Pulmonology
Findings: high fever, cough, stridor, unresponsive to treatments for croup
Notes: Unlike epiglottitis, there is no drooling, and there is a cough.
Blastomycosis
Category: generalpediatrics-Pulmonology
Findings: cough and hemoptypsis, weight loss, chest pain, verrucous skin lesions and microabscesses, upper lobe infiltrates and cavitary lesion, fever, exposure to spores from soil
Notes: Seen often in Arkansas, Illinois, Mississippi, and Wisconsin
Question: What fits these findings?
Bronchiectasis
Category: generalpediatrics-Pulmonology
Findings: cough worse with positional changes, hemoptysis, associated with cystic fibrosis and autoimmune disorders, airway widening
Notes: Caused by damage and widening of bronchi
Question: What fits these findings?
Choanal Atresia
Category: generalpediatrics-Pulmonology
Findings: stridorous loud breathing since birth, tachypnea, cyanosis, worse at rest and better when crying
Notes: Also known as Valley Fever. Seen commonly in Arizona, California, Nevada, and New Mexico.
Congenital Diaphragmatic Hernia
Category: generalpediatrics-Pulmonology
Findings: respiratory distress in newborn, pulmonary hypertension, decreased breath sounds on the left side, flat or scaphoid abdomen
Notes: Treat with gastric decompression with NG tube, gentle ventilation, and management of pulmonary hypertension. When stable, obtain echocardiogram to check for commonly associated congenital heart diseases.
Findings: focal infiltrates on CXR, hilar adenopathy, mild fever and cough, exposure to farm animals
Notes: Seen with bat and chicken droppings, and found commonly in the Ohio and Mississippi river valleys.
Idiopathic Pulmonary Hemosiderosis
Category: generalpediatrics-Pulmonology
Findings: cough with hemoptysis, iron deficiency anemia, fatigue, worsening dyspnea, sputum with hemosiderin-laden alveolar macrophages
Laryngomalacia
Category: generalpediatrics-Pulmonology
Findings: inspiratory stridor in 3 month old infant worse when supine or agitated, no fever or signs of infection
Notes: Due to prolapse of epiglottis or tissue or cartilage near epiglottis. Obtain ENT consult for flexible laryngoscopy. Unlike croup, this is not caused by an infection, usually viral.
Question: Which disease is associated with these findings?
Laryngomalacia
Category: generalpediatrics-Pulmonology
Findings: inspiratory stridor in infant, worse when child is supine or upset, retractions, floppy larynx cartilage
Notes: Most cases will self-resolve by one to two years of age. Severe cases may require supraglottoplasty to keep airway open above vocal cords.
Question: What fits these findings?
Mycoplasma Pneumoniae
Category: generalpediatrics-Pulmonology
Findings: cough and wheezing in adolescent, fever, joint pain, splenomegaly, erythema multiforme, pharyngitis, confusion, multifocal diffuse infiltrates or lobar consolidation
Question: What organism causes these findings?
Pulmonary Sequestration
Category: generalpediatrics-Pulmonology
Findings: recurrent pneumonia on same side, chronic cough
Notes: Lung tissue disconnected from trachea and has its own blood supply
Spasmodic Croup
Category: generalpediatrics-Pulmonology
Findings: croup and mild stridor at night, asymptomatic during day, treated with gastric reflux and allergy medications
Subglottic Stenosis
Category: generalpediatrics-Pulmonology
Findings: inspiratory and expiratory stridor, history of intubation, dyspnea, may be congenital or due to trauma
Question: What fits these findings?
Toxocara Canis
Category: generalpediatrics-Pulmonology
Findings: wheezing, abdominal pain, leukocytosis, eosinophilia, lung infiltrates, multiple systems affected, pet dog
Notes: Causes visceral larva migrans. Treat with albendazole.
Question: Which organism causes these findings?
Tracheomalacia
Category: generalpediatrics-Pulmonology
Findings: expiratory stridor worsened with agitation, usually resolves by 6 to 12 months
Notes: Due to collapsing tracheal wall. Unlike laryngomalacia, is expiratory instead of inspiratory.
Question: What fits these findings?
Tracheomalacia
Category: generalpediatrics-Pulmonology
Findings: expiratory stridor in infant, frequent respiratory infections
Notes: Due to obstruction in lower trachea
Vascular Ring
Category: generalpediatrics-Pulmonology
Findings: trouble feeding in infant, gastroesophageal reflux, expiratory stridor since birth, evaluated with barium swallow, sometimes caused by double aortic arch
Notes: Perform CT angiography or MRA for further workup
Question: What fits these findings?
Vocal Cord Dysfunction
Category: generalpediatrics-Pulmonology
Findings: wheezing, chest tightness, shortness of breath or feeling of suffocation, unresponsive to albuterol
Notes: Vocal cords close instead of open when breathing.
Question: What fits these findings?
Vocal Cord Paralysis
Category: generalpediatrics-Pulmonology
Findings: hoarse or weak cry in infant, inspiratory high-pitched stridor