A 22-month-old boy presents to the Emergency Department with a sudden onset of respiratory distress during a family picnic. He is febrile and has otherwise been well. Physical exam... A 22-month-old boy presents to the Emergency Department with a sudden onset of respiratory distress during a family picnic. He is febrile and has otherwise been well. Physical examination demonstrates unilateral wheezing in the right hemithorax. Which of the following is the most likely to be seen in his chest X-ray? A. Pneumothorax on the right side B. Consolidation of the right lower lobe C. Lower lobe collapse on the right side D. Hyperinflation of the right lung with mediastinal shift to the left Read more

Understand the Problem

The question describes a toddler presenting with sudden respiratory distress and unilateral wheezing. We need to determine the most likely finding on a chest X-ray given the clinical scenario, which strongly suggests a foreign body aspiration.

More Information

The sudden onset of respiratory distress and unilateral wheezing in a 22-month-old, who was previously well, strongly suggests foreign body aspiration. The most likely location would be the right main bronchus, due to its more direct angle from the trachea. This can cause a 'ball-valve' effect, where air can enter the lung during inspiration but cannot exit during expiration, leading to hyperinflation. The mediastinum shifts away from the hyperinflated lung due to the pressure difference.

Tips

A common mistake is to focus on infectious causes of wheezing, but the sudden onset in a previously healthy child is a key indicator for foreign body aspiration. Always consider the possibility of foreign body aspiration in young children presenting with acute respiratory symptoms.

Sources

• Wheezing Exacerbations in Early Childhood: Evaluation, Treatment ... - pmc.ncbi.nlm.nih.gov
• Wheezing in children - Mayo Clinic - mayoclinic.org