Atwal Rajan, Stewart Charles
Department of Paediatric Emergency, Chelsea and Westminster Hospital, Chelsea, London.
Medicine (Baltimore). 2018 Jun;97(24):e10580. doi: 10.1097/MD.0000000000010580.
We describe the unique case of a child with pneumonia presenting with acute scoliosis and abdominal pain, without any typical features of the disease.A 10-year-old girl presented to the emergency department on 3 consecutive days with right-sided abdominal pain. There were no associated features, in particular, no fevers or respiratory symptoms. On the first 2 presentations, observation,examination, and blood test findings were unremarkable. Chest x-ray and abdominal ultrasound were also normal. On the third presentation a marked scoliosis was noted and abdominal examination revealed right-sided tenderness with rebound. The patient was admitted and a computed tomographic scan of the abdomen arranged. Unexpectedly, this revealed a right lower lobe pneumonia and associated pleural effusion. Despite treatment, the parapneumonic effusion enlarged rapidly and she developed respiratory distress, necessitating transfer to a tertiary centre.The diagnosis of pneumonia can be challenging because of a lack of respiratory signs, the masking of systemic features by antipyretic effects of first-line analgesics, and a high rate of false-negative chest radiographs. The development of acute scoliosis should lead the clinician to strongly consider pneumonia in such circumstances.
我们描述了一例独特的病例，一名患有肺炎的儿童出现急性脊柱侧弯和腹痛，无该疾病的任何典型特征。一名10岁女孩连续三天因右侧腹痛到急诊科就诊。无相关特征，特别是无发热或呼吸道症状。在前两次就诊时，观察、检查及血液检查结果均无异常。胸部X光和腹部超声也均正常。第三次就诊时发现明显的脊柱侧弯，腹部检查显示右侧有压痛及反跳痛。患者入院并安排了腹部计算机断层扫描。出乎意料的是，扫描显示右下叶肺炎及相关胸腔积液。尽管进行了治疗，肺炎旁积液仍迅速增大，她出现了呼吸窘迫，因此需要转至三级医疗中心。由于缺乏呼吸道体征、一线镇痛药的退热作用掩盖了全身特征以及胸部X光片假阴性率高，肺炎的诊断可能具有挑战性。在这种情况下，急性脊柱侧弯的出现应促使临床医生高度怀疑肺炎。
