Opening Pandora’s Box: A Chest Radiograph in a 5-Month-Old With Bronchiolitis

Abstract

A 5-month-old, otherwise healthy, former 35-week male infant, presented to our pediatric emergency department with the chief complaint of cough and "sucking in" at the chest. The patient was in his usual state of health until 1 day prior to presentation when he developed nasal congestion. Before coming into the hospital, the family noted decreased oral intake and only 3 wet diapers in the past 24 hours. No other past medical history was notable except intubation at time of delivery due to respiratory distress requiring surfactant administration. Past surgical history was significant for bilateral inguinal hernia repair and circumcision. He is on no medications currently and immunizations are up to date. He lives at home with his nonsmoking parents.In the emergency department, the patient's vitals were as follows: heart rate, 137; blood pressure, 94/51; temperature, 36.8; respiratory rate, 56; and pulse oximetry, 97% on room air. Physical examination revealed an infant in mild respiratory distress with tachypnea, subcostal retractions, clear nasal discharge, and coarse breath sounds throughout. The patient was treated with nasal suctioning, and the decision was made to send for chest radiograph.

Radiographic changes in ribs following clipping of patent ductus arteriosus in preterm infants

“…10 In the setting of non-accidental trauma, rib fractures are more common at the posterior arc of the rib closer the vertebral bodies. 1,2 This site is more prone to fracture because the levering force during the physical abuse tends to be directed more posteriorly and the area at which the rib angulates forward receives the brunt of the force leading to fractures in this area. 1,2 Rib fractures in association with non-accidental trauma tend to involve multiple ribs from both sides, whereas the changes in the ribs following surgical ligation of the PDA tends to involve only the ipsilateral fourth and fifth ribs as demonstrated in this study.…”

“…Abnormalities of ribs identified on a plain chest radiography in infants can indicate a systemic or metabolic disease or trauma, including non-accidental trauma. 1 , 2 …”

“…Abnormalities of ribs identified on a plain chest radiography in infants can indicate a systemic or metabolic disease or trauma, including non-accidental trauma. 1,2 Patent ductus arteriosus (PDA) is the persistence of the fetal ductus arteriosus between the aorta and pulmonary artery beyond the immediate postnatal period. 3 The pathophysiological effects of isolated PDA is dependent on the gestational age of the patient and the size of the PDA.…”