Presentation
Cough and increased work of breathing.
Patient Data
There is cardiomegaly and right upper lobe consolidation. The consolidation is most likely due to infection, but the heart size is large and further evaluation should be considered.
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The horizontal fissure is the lower margin of the right upper zone opacification meaning that it is within the right upper lobe. The fact that the location of the fissure has not changed suggests that this is due to a process that is preserving lung volume (consolidation) rather than one that reduces volume (atelectasis).
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The cardiomediastinal contour:
- blue: left ventricle and left ventricular apex
- yellow: right atrium
- red: left atrium
- orange: aortic knuckle
Case Discussion
There is obvious cardiomegaly, which in this case was demonstrated to be secondary to a pericardial effusion on an echocardiogram.
The prominence of the left atrium is not uncommonly seen in pediatric patients and is not necessarily pathological. It shouldn't be misinterpreted as a mediastinal mass.
There is infective right upper lobe consolidation.
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