PMC6664550_01
Chest radiographs showing progression of disease. (a) Presentation to ED. (b) Presentation to PICU. (c) Left hemithorax white-out, with percutaneous chest tube. (d) Right pleural effusion following drainage with the percutaneous chest tube. (e) Extensive pneumatocele development prior to pneumonectomy. (f) Resolution of acute disease, following removal of noninvasive respiratory support.
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fig1
Chest X-ray showed multifocal pneumonia (Figure 1(a)). He was intubated for type 1 respiratory failure, with worsening bilateral consolidation and development of left pleural effusion (Figure 1(b)). Left chest tube (8.5 French pig-tail catheter) was placed on day 4 of admission following effusion progression (Figure 1(c)), with drainage of cloudy neutrophilic exudate. The patient continued to deteriorate, with development of left bronchopleural fistula (Figures 1(d) and 2). While on ECMO, extensive left lung pneumatoceles developed, leaving minimal normal lung parenchyma on the left (Figure 1(e)). Repeat chest X-ray reveals normalization of the right hemithorax (Figure 1(f)).