Let me just say that this post is in no way intended to offend any of the radiologists out there who may stumble upon this blog.
So the kid we saw in clinic last night came back this morning. He felt much better. He was playing. He was drinking. My attending decided to get a chest x-ray. The wet read on the x-ray by the radiology resident was that there was no consolidation, no pneumonia.
He still had crackles in his right lung fields, mostly over the middle lobe.
My attending and I scratched our heads for a moment, then looked at the x-ray ourselves. The right heart border on the AP projection was fuzzy, a classic sign of a right middle lobe pneumonia. The lateral projection had a clear consolidation in, you guessed it, the right middle lobe.
We prescribed another 6 days of antibiotics and sent them home.
The moral of this story is to trust your physical exam, as well as your own read on an x-ray. You are your patient's best advocate.