Introduction:
A ten 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 two presentations observation, examination and blood test findings were unremarka
ble.
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 ab
domen 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.
Conclusions:
The diagnosis of pneumonia can be challenging due to 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 sco
liosis should lead the clinician to strongly consider
pneumonia in such circumstances