TY - JOUR T1 - A 4‐yr‐old presenting with chronic cough and asymmetrical chest JF - European Respiratory Journal JO - Eur Respir J SP - 861 LP - 864 DO - 10.1183/09031936.03.00002603 VL - 22 IS - 5 AU - A.V. Sridhar AU - M. Tofeig Y1 - 2003/11/01 UR - http://erj.ersjournals.com/content/22/5/861.abstract N2 - A 4‐yr‐old female was referred by her general practitioner with history of recurrent cough of 18 months duration. The cough was predominantly nocturnal with no associated wheeze, fever or systemic symptoms and no symptoms of gastro-oesophageal reflux. There were no exercise-induced symptoms. Asthma was suspected and she had been treated with inhaled salbutamol with no significant improvement in her symptoms. There was no history of recurrent chest infections, foreign body aspiration or previous hospital admissions. On examination her weight was on the 3rd centile and height on the 50th centile. There were no cyanosis, clubbing or ear, nose and throat abnormalities. She had a markedly asymmetrical chest with less prominent right hemithorax compared with the left and mediastinal shift to the right. Breath sounds were diminished on the right side with no wheeze or crepitations. The rest of the cardiovascular examination was normal. There were no other abnormalities on clinical examination. In view of her chronic cough and failure to thrive she had a mantoux test, which was strongly positive. She had bacille Calmette-Guerin vaccination at birth and there was no recent contact with tuberculosis (TB). The sputum was negative for Mycobacterium tuberculosis. She was given TBB chemoprophylaxis with Isoniazid and Rifampicin for 6 months, during which she had a symptomatic improvement in her cough. A chest radiograph (fig. 1⇓) and computed tomography (CT) scan of the thorax (fig. 2⇓) revealed characteristic findings.Fig. 1.— Chest radiograph of … ER -