Pneumonia with wheeze
Dr Ira Shah
Medical Sciences Department, Pediatric Oncall, Mumbai
Address for Correspondence: Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056. India
Clinical Problem :
A 10 months old boy presented with cough for 7 days, fever for 3 days and breathlessness for 2 days. On examination, he was in distress with respiratory rate of 60, min, had suprasternal, intercostals and substernal retractions with flaring of alae nasi. Chest examination revealed decreased air entry in right subscapular area with bilateral wheeze. Investigations showed:
• WBC count = 18,000, cumm {30 percent polymorphs, 70 percent lymphocytes}
• Hemoglobin = 12 gm, dl, ESR = 36 mm at end of 1 hour.
• Chest X-Ray = right lower zone consolidation with bilateral hyperinflation.
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Why does this pneumonia have bilateral wheeze_?
Discussion :
This child has a right lower lobe pneumonia which can explain the respiratory distress. However, this child had predominantly constitutional symptoms in form of cough initially which then lead to fever. Thus a possibility of viral infection is there. Thus, this child could have started of as a viral respiratory illness with superadded bacterial pneumonia or aspiration {Aspiration usually leads to right upper lobe pneumonia if child aspirates on lying down or could lead to right lower lobe pneumonia if it aspirates on upright position}. Pneumonia is affection of alveoli and leads to crepitations. Wheeze is seen with involvement of bronchi and is usually due to bronchitis {infective} or asthma. Thus, this child also has bronchitis apart from pneumonia. However presence of suprasternal retractions suggests extrathoracic pathology. Thus bronchitis with extrathoracic pathology is laryngotracheobronchitis or croup. Thus, in this child apart from superadded bacterial or aspiration pneumonia, there is croup. X-Ray of neck proved presence of steeple sign and child improved with Adrenaline nebulization.
Thus, wheeze in a child with pneumonia is unusual and one must consider other pathologies.
E-published: April 2011 Vol 8 Issue 4 Art No. 28
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