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Respiratory Medicine
Published in Stephan Strobel, Lewis Spitz, Stephen D. Marks, Great Ormond Street Handbook of Paediatrics, 2019
Colin Wallis, Helen Spencer, Sam Sonnappa
Some children may present with wheeze, shortness of breath and failure to thrive. On clinical examination digital clubbing may be present and persistent crackles with or without wheeze may be heard on auscultation.
The Interstitial Pneumonias
Published in Lourdes R. Laraya-Cuasay, Walter T. Hughes, Interstitial Lung Diseases in Children, 2019
The presence of unexplained progressive pulmonary insufficiency associated with a refractory nonspecific failure to gain weight is suggestive but not diagnostic of UIP. In infants, a vigorous search for a familial history suggestive of pulmonary fibrosis must be made as it appears that the incidence of familial background for IPF is high. Dry or paroxysmal cough which may not be impressive occurs. Occasionally, there is sputum production. Dyspnea and tachypnea may be prominent in infants. Low-grade fever may accompany cough, cyanosis, and failure to gain weight. Clubbing of the digits is a late finding and usually appears in adolescence. The pulmonary lesion may be silent and resistant to clinical detection for many years. Digital clubbing may precede obvious pulmonary symptoms. Pathologic, physiologic, and radiographic changes may manifest themselves before the appearance of clinical symptoms.130
Single best answer (SBA)
Published in Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon, Radiology for Undergraduate Finals and Foundation Years, 2018
Tristan Barrett, Nadeem Shaida, Ashley Shaw, Adrian K. Dixon
A 46-year-old man, with long-standing bronchiectasis, presents with burning joint pain of the fingers and swelling of the right wrist. On examination there is noted to be bilateral digital clubbing. An X-ray is performed and shows periosteal proliferation of new bone in the distal radius and ulna. The appearances are otherwise normal. What is the most likely diagnosis? Caffey’s disease.Hyperparathyroidism.Hypertrophic osteoarthropathy.Osteoarthritis.Rheumatoid arthritis.
Pediatric Hypersensitivity Pneumonitis: Clinicopathologic Characteristics of Two Cases with Fungal Triggers
Published in Fetal and Pediatric Pathology, 2022
Catherine Gonsalves, Dima Ezmigna, Archana Shenoy
A 6-year-old male with past medical history of uncontrolled asthma presented with recurrent pneumonia requiring two hospitalizations. On his first admission, he was transferred from an outside hospital for persistent cough, fever, shortness of breath, and increased work of breathing, refractory to treatment for an asthma exacerbation. On physical examination, he was tachypneic with a respiratory rate of 58 breaths per minute. Oxygen saturation was 88% on room air, requiring 1.5 L of oxygen by nasal cannula to maintain 100% saturation. Heart rate was 89 beats per minute and blood pressure was 104/48 mm of Hg. Body weight was 14.5 kg (less than 5th percentile for age). Chest auscultation revealed bilateral crackles and decreased air entry. Digital clubbing was also noted. His chest radiograph showed diffuse, prominent interstitial markings, suspicious for a viral or inflammatory airway process.
Extrapulmonary tuberculosis
Published in Expert Review of Respiratory Medicine, 2021
Surendra K Sharma, Alladi Mohan, Mikashmi Kohli
General physical examination may reveal digital clubbing (empyema). Respiratory system examination reveals mediastinal shifexaminations revealed mediastinal shiftst to the opposite side, reduced thoracic movements, intercostal tenderness, reduced tactile vocal fremitus, a stony dull percussion note, and reduced or absent breathing sounds on the affected side. In classical pleural effusion, the highest point of the dull note will be evident in the axilla. A horizontal upper level of the percussion note, shifting dulness, succession splash suggests hydropneumothorax; the presence of amphoric breath sounds may point to bronchopleural fistula. In TB empyema, intercostal fullness, and tenderness may be evident. TB empyema may present as empyema necessitans and a chest wall mass with an expansile cough impulse or a draining sinus tract may be evident.
Cystic bronchiolectasis and airspace enlargement mimicking honeycombing in rheumatoid arthritis-associated interstitial lung disease
Published in Modern Rheumatology Case Reports, 2019
Mitsuhiro Moda, Hitoshi Tokuda, Tamiko Takemura, Masaaki Yuki, Yuko Iwata, Shogo Kasai, Yasumi Okochi
On admission, her temperature and respiratory rate were 36.6 °C and 18 breaths/min, respectively. Auscultation of the chest revealed bibasilar inspiratory crackles. No digital clubbing was seen, but she exhibited mildly deformed bilateral finger joints. She had been receiving tocilizumab 162 mg/2 weeks subcutaneously. The RA destruction of his finger joints and knee joints was defined as Steinbrocker stage III and stage II, respectively. The results of arterial blood gas analysis on room air were pH 7.4, PaCO2 42.7 Torr, PaO2 77.5 Torr and HCO3-26.3 mmol/L, indicating mildly impaired oxygenation function. Pulmonary function testing demonstrated a normal forced vital capacity (FVC) of 2.20 L (105.8% predicted), normal percentage of forced expiratory volume in the first second (77.3%), and mild reduction of diffusion capacity (%DLCO 57.9%). Flow rate at 50% of FVC (V ̇50) was 2.41 L/s, flow rate at 25% of FVC (V ̇25) was 0.32 L/s, and V ̇50/V ̇25 was 7.53, indicating dysfunction of the small airways.