You are on your pediatric rotation and are asked to examine a 10-year-old girl
with Down's syndrome who was admitted with a 10-day history of fever, rigors, and
progressive dyspnea that had failed to respond to a 5-day course of intravenous gentamicin.
On your exam her BP is 105/70, pulse 110 and regular, temperature 38.5°C, and
respirations 20 breaths/minute. Her breath is fetid. You note a flat percussion note,
absent tactile fremitus, and diminished breath sounds over the right posterior chest.
Her admitting chest x-ray is shown below.
What is your diagnosis, what test(s) would you order to confirm your suspiciops, and what treatment, if any, do you recommend?
To receive credit, please e-mail your answers to smithj@etsu.edu