The patient is a 7-year-old boy who presents to urgent care at midnight with a four-day history of fever and cough.
Two days prior, a throat culture administered elsewhere showed nothing suspicious. The parents brought him to urgent care tonight because of increasing chest pain, which began after the visit to the primary care physician.
On exam, you find the child is not in respiratory distress, but has decreased air entry on the left side of his chest. His temperature is 101.3°F, with SAT of 94.

View the x-ray taken (Figure 1) and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Clinical Challenge: September, 2008

Nahum Kovalski, BSc, MDCM

Clinical Researcher at TEREM Emergency Services
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