22 month old with symptoms suggestive of bronchiolitis and a radiograph that fits the story.
The vast majority of these patients will be discharged home with no further treatment. A small proportion will be admitted for observation. Most of the children who are observed will improve with some nasal oxygen and require no further treatment.
Spontaneous air-leak is a complication of bronchiolitis. Gas usually dissects up the axial interstitium towards the hila resulting in pneumomediastinum and, depending on the volume of gas, surgical emphysema in the neck. This may all occur in the absence of pneumothorax.