Figure – This infant's chest radiograph showed a right middle lobe infiltrate and peribronchial cuffing in both lung fields; these findings were consistent with the final diagnosis of recurrent respiratory illness manifesting as acute bronchiolitis and right middle lobe pneumonia.
I read with interest Drs Ha and Wilson's "What's Your Diagnosis?" case of an infant with a history of wheezing and dry cough ("History of Cough in an Infant and a Toddler") (Figure). In a setting such as this, one should also consider the possibility of foreign-body aspiration, which can result in recurring wheezing and pneumonia. The fact that this infant has a 2-year-old sister makes it quite possible that the toddler had shared food and other small objects with her younger brother, who at age 6 months would be developmentally capable of grasping his sister's offerings and putting them in his mouth. It's too bad a lateral chest radiograph was not available for assessment of this possibility.
Richard D. Olufs, MD
We appreciate Dr Olufs' pertinent observation that foreignbody aspiration should be considered in infants and toddlers with a first presentation of reactive airway disease. This is particularly necessary when unilateral atelectasis is present—a finding that is best identified by assessing asymmetry on a lateral film, as Dr Olufs suggests. Although this infant's lateral radiograph was not pictured in the journal, it was available and did not suggest foreign-body aspiration. Nonetheless, follow-up consideration of this diagnosis is always necessary, because children who have aspirated a foreign object may show a transient response to bronchodilator therapy.
Golder N. Wilson, MD, PhD
Clinical Professor of Pediatrics
Texas Tech University Health Sciences Center