An unusual cause of failure to thrive.

A 9 months old male child presented ,1·ith the complaints of failure to thriYe. F{;(·r;mg had been inadequate because of fatigue on sucking. He deYeloped noisy breathing at 5 months of age and was treated for repeated respiratory tract infections without a specific diagnosis. Physicai examination reYcalccl that his height and weight were helo\\ tne third percentile. He had noticeable i'lterc,,sta'. a11cl su bcostal ret ructions, although mo,·pmcni:; of , he cl1esL were symmetrical bilaterall:. There \\d.� a dull 1wrcussion note ancl reduced air entry on t.he nght �icle of the chest but no signs of meclias.inal shift wen' elicitahle. Liver could nr,t be palpated. X-ray chest showed obliteration of right iung field with uniform opacity Oct·upying the middle and lower zones. The right hemidiaphr.gm ,ms not ,·isible 1Figs. I and 2l. An ultrasound examillation confirm,id high int rat hnra.cic liver with poorly visua.:iznd right h('midiaphragm. The right lung showed collapse wit hour e\'iclence of pleural effusion.