Presentation
Right lower chest pain, difficulty in breathing and cough with whitish sputum for two days. No fever or hemoptysis.
Patient Data
Inhomogeneous air space opacity in the right lower lung zone with loss of right hem-diaphragm outlines; the remaining lung zones are well-aerated and clear. Small right-sided pleural effusion. No pneumothorax is seen.
Small non-septated right-sided pleural effusion with consolidative changes in the underlying lower lobe. Multiple small hyperechoic foci, representing air bronchograms, are seen within the consolidative lung.
Annotated images showing consolidation, air bronchograms and pleural effusion.
Case Discussion
Respiratory panel (multiplex PCR) came positive for human adenovirus. Other laboratory investigations show high CRP (C-reactive protein) with normal WBC count.
Chest ultrasound can be used to access the size of pleural effusion and differentiate between the lung consolidation and atelectasis. Dynamic air bronchogram aids in the differentiation of consolidation from the atelectasis. Dynamic air bronchograms are more in favor of pneumonia whereas static or no air bronchograms are more in favor of atelectasis. Size of pleural effusion is also a helpful feature. Large pleural effusion raises the possibility of underlying compression atelectasis whereas a small effusion is more in favor of consolidation 1.
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