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Assembly

The Air is Everywhere

Authors
Abigail Strang, MD1 and Aaron Chidekel, MD1
Nemours/A.I. duPont Hospital for Children, Division of Pediatric Pulmonology
Wilmington, Delaware 19803, USA


Case

Introduction

A 12-year-old male with a history of mild persistent asthma presented to the Emergency Department (ED) with acute onset of chest pain and a “crackling” feeling along his sternum. Two days prior he was seen by his pediatrician for coughing and wheezing associated with nasal congestion and sore throat. He was prescribed albuterol, prednisone, and azithromycin. In the ED, the patient had normal vital signs for age and a room-air oxygen saturation of 100%. On auscultation, lung exam showed diffuse end-expiratory wheezing. Crepitus was palpated in the neck, axillae, and along the sternum. The patient denied smoking or huffing, and there was no history of vomiting, strenuous physical activity, or trauma. A rapid respiratory panel was positive for Rhinovirus. A chest CT was obtained with findings as below:

Chest CT

Question:

Based on the chest CT findings, what are the best next steps in the management of this patient?

A. MRI of the thoracic spine
B. Medical management of bronchospasm with conservative management of air-leak syndrome
C. Contrast esophagram
D. Neurosurgical evaluation

Answer