Wheezing that is not asthma in a 4-year-old child

CASE


A 4-year-old female with no significant medical history was admitted for 
wheezing and shortness of breath. Symp­toms had begun about 10 months prior with a persistent cough and intermittent wheezing. The patient also had intermittent fevers up to 103°F. Her primary care provider had evaluated her and prescribed albuterol and dornase alfa (Pulmozyme), which provided some temporary relief; however, symptoms had quickly returned. No chest radio­graphy was done at the time. 


On examination, the patient was comfortable and in no acute distress. Vital signs were as follows: temperature, 100°F; BP, 117/62 mm Hg; heart rate, 110 beats per minute; respiratory rate, 30 breaths per minute. Oxygen saturation was 91% on 2 L of oxygen delivered by nasal canula. Heart rhythm was regular with no murmurs, rubs, or gallops. Auscultation of the lungs revealed diminished breath sounds on the right with a slight wheeze. The right superior chest was dull to percussion. The chest film revealed a large, rounded mass filling most of the right, upper, and mid chest (Figure 1).