Dr. Adah M. Duncan: The patient, a 7-year-old white boy, had been treated for three weeks with antibiotics for what was thought to be upper-respiratory tract infection and had shown no response. During this period, he had become anorectic and had lost 2.7 kg (6 lb). During the week before admission, the patient was noted to turn blue and become acutely short of breath when he bent forward. On the day of admission, a stridor developed and he was severely short of breath at rest.
At the time of admission, the respiratory rate was 32 per minute, temperature was 102 F (38.9 C), and blood pressure was 115/90 mm Hg. His face was pale and puffy with venous engorgement in the neck and over the chest. There was a firm, palpable supraclavicular lymph node on the left side measuring 1.5 cm in diameter. Breath sounds were decreased bilaterally, and there