100 PAEDIATRIC PICTURE TESTS 61 Question 31 a) What is the diagnosis? b) List three potential causative organisms. ¢) List four recognized complications of your diagnosis.62 100 PAEDIATRIC PICTURE TESTS. Answer to Question 31 a) Right middle lobe pulmonary abscess b) Pneumococcus Staphylococcus Haemophilus influenzae Klebsiella pneumoniae Mycobacterium tuberculosis Mycotic infections Entamoeba histolytica Anaerobes Legionella c) Bronchiectasis Bronchial stenosis Haemorrhage Bronchopleural fistula and empyema Secondary sepsis including cerebral abscess Mediastinitis Osteo-arthropathy e Rightlung is more commonly affected. Predisposing factors include aspiration of foreign bodies, cysts, poor oral hygiene and immuno- suppression. e Haemoptysis is common. Micro-abscesses are more common in cystic fibrosis than large abscesses. Clubbing may develop. e Failure of resolution indicates the need for bronchoscopy. Recur- rence may be due to ciliary dyskinesia or Kartagener syndrome. e Residual defects, not detected on plain X-ray, may be seen on ventilation/perfusion isotope scanning. O'Callaghan C 1989 Paediatric radiology. Wolfe, London100 PAEDIATRIC PICTURE TESTS 63 Question 32 This picture was obtained at a routine 6 week infant examination. a) What is demonstrated? b) What investigations would you perform? What is the management?