C, B A right upper lobe infiltrate separate from the thymus and scapula shadows is .

20,21
.present

The clinical scenario and radiographic findings are consistent with a pneumonic

.process

C, B, D The stat chest X-ray reveals air in the pericardium; in conjunction with the .24–22
deteriorating

.clinical condition, this yields a diagnosis of tension pneumopericardium

Treatment requires prompt evacuation of the pericardial space. An evaluation of a

;patient in respiratory distress or failure on a ventilator requires evaluation of the circuit

however, in this case the diagnosis is evident (and time-critical) with the chest

;X-ray. A pericardiocentesis would relieve the air but it may be expected to reaccumulate

a more definitive treatment may require that a catheter with a stopcock be

left in place or a pericardial window by a thoracic surgeon be created. The condition

is somewhat rare. The mechanism is a high alveolar pressure leading to rupture and

air dissecting into the hilum and mediastinum with entrance to the pericardial space

.via the membrane reflection on the pulmonary vessels. Pacing wires are also visible

.This would be consistent with a post-op cardiac patient

C, D, B, E, D Aleft lower lobe and right lower lobe infiltrate are visible. Blood cultures .29–25
are appropriate

in infants and the toxic-appearing child. Antibiotic coverage with a presumption

of a possible bacterial etiology is not unwarranted. M. pneumoniae is the most

common pathogen in school age children. Viruses predominate from 3 months

through 5 years. Group B and Listeria are concerns for neonatal infection. Followup

.care is of utmost importance in the ambulatory setting

Classic teaching has focused on the typical versus atypical pattern, but a great

amount of overlap exists in presentation. It must be emphasized that a bilateral infiltrate

.pattern on X-ray does not automatically qualify the infiltrate as typical or atypical

A typical pneumonia includes a high spiking fever, abrupt onset, productive

cough, toxic appearance, and localized lung findings. Atypical pneumonias are

associated with a gradual onset, low-grade fever, nonproductive cough, general

.malaise, and headache