Sheffield Children’s Hospital, Sheffield
A 7 month old baby seen in respiratory clinic following referral by local hospital for persistent chestiness and chronic lung collapse on CXR. He was born at 36 weeks, was well and thriving. He started with chesty cough and occasional grunting from 3 months of age, admitted at 4 months with bronchiolitis type illness, and reduced feeding. O/E had mild temperature (37.8), reduced air-entry on left lower lobe, and raised CRP of 73, CXR showed complete collapse/consolidation of left lung, over inflation of right lung with mediastinal shift. He made reasonable recovery after short course of iv antibiotics and physiotherapy. On follow up he continued to have mild respiratory distress, repeat X-rays showed persistent left lower lobe collapse. In view if this he was referred to respiratory for bronchoscopy.
On respiratory review he was noted be intermittently grunting and reduced air-entry on left lung. Cardiac examination showed a soft systolic murmur (gr 2/6) along left upper sternal edge, femorals good volume, no organomegaly. Cardiac work up done, echo- showed severe dilated left heart, mitral regurgitation, severely impaired function and abnormal origin of left Coronary artery from Pulmonary artery. ECG- showed ST elevation, T wave inversion and Deep Q waves in lateral leads. CT showed complete collapse of left lung due to compression by the enlarged heart. He was urgently transferred to cardiac centre for repair of ALCAPA.
What was thought to be a primary respiratory problem in this infant turned out to be a significant cardiac anomaly.