ANSWER1. similar to first cxr
2. large homogenous added density occuping most of the left hemi-thorax
3 .large cavity with a mobile air fluid level in the superior aspect
4. small amount of pleural fluid as seen in the lateral decubitus film
5. shift of mediastinum The diagnosis is consistent with a lung abscess
PROGRESSAt this point we decided to continue treatment with antibiotics alone
INVESTIGATIONSWBC: 7.5, Neut:2.4, Band 1.3, CRP (C reactive protein) 300 mg/l.
A blood culture sent and she was started on clindamycin and cefotaxime intravenously. She gradually improved and became afebrile once again. Nine days later she was a well looking child, but still had markedly decreased breath sounds on left side.
lab results at that time included: WBC: 9.2 Neut: 3.7 band :0.1, CRP
:32 mg/l. Blood cultures had been negative and clindamycin was discontinued.
BELOW IS HER CHEST RADIOGRAPH
WHAT IS YOUR DIAGNOSIS NOW?