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Assembly

What White Lungs You Have

Author
Julia X. Lee1, MD, Daniel T. Atwood, MD1, Kenan Haver, MD1
1Harvard Medical School, Boston, Massachusetts; Division of Pulmonary Medicine, Boston Children's Hospital, Boston, Massachusetts


Case

A 4-year-old-girl with anaplastic ependymoma complicated by central sleep apnea and hydrocephalus status post ventriculoperitoneal shunt placement two years prior presented to pulmonary clinic with worsening hypoxemia. Her sleep apnea is managed with nasal cannula due to intolerance of BiPAP. Over the past few weeks, her nighttime oxygen requirement slowly increased from 1L/min to 3L/min. On an unprompted random daytime check, her oxygen saturation was 80%, which improved with 1L/min of supplemental oxygen. She was slightly fussy but otherwise her neurologic baseline with no new fever, cough, difficulty breathing, cyanosis, or fatigue. Her vitals in clinic were as follows: temperature 36.4 °C, heart rate 75 bpm, respiratory rate 20 bpm, SpO2 98% on 1L/min. Her left lung sounds were markedly diminished on auscultation. A chest radiograph was obtained.

Chest Radiograph
Chest Radiograph

Question

What is the most likely cause of this patient’s presentation?

A. Infection
B. Iatrogenic
C. Cardiac
D. Malignancy

Answer