Right upper lobe pneumonia and iatrogenic subdiaphragmatic free gas

Case contributed by Henry Knipe
Diagnosis certain


Fever, tachypnea and tachycardia.

Patient Data

Age: 11 years
Gender: Female

Airspace consolidation with air bronchograms obscuring the right superior mediastinal contour, in keeping with right upper lobe pneumonia. Sliver of free gas under the right hemidiaphragm. High-flow oxygen mask present. 

Case Discussion

This case has two main findings:

  • obvious right upper lobe pneumonia
  • less obvious free gas under the right hemidiaphragm

How are the two findings related? The patient was 24 hours post-operative for appendectomy, and had developed respiratory symptoms, most likely an aspiration pneumonia given the history and that the right upper lobe is affected. 

This case demonstrates a potential satisfaction of search error, where the on spotting the right upper lobe pneumonia further abnormalities are not sought. 

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