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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 1 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 1

Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed

Chief Complaint:
Former 23 week premature male, now 10 weeks old, with a cystic lesion in the lung.

Clinical History:
The patient was a former 615 gram, 23 and a half week premature male, who is now 10 weeks old. The patient had a history of hyaline membrane disease that was treated initially with three doses of Survanta artificial surfactant and steroids. He went on to develop chronic lung disease, pulmonary interstitial emphysema, and a cystic lesion in the right lower lobe. The cystic lesion was treated without success first with a balloon catheter in the right bronchus to selectively ventilate the left lung, and then with placement of a chest tube into the lesion. The cystic lesion was slowly increasing in size and the patient required further imaging of the lesion to allow for further treatment planning. The patient also had a history of necrotizing enterocolitis that caused a bowel perforation that was treated medically.

Clinical Physical Exam:
Ventilated premature infant in respiratory distress.

Clinical Labs:

Clinical Differential Diagnosis:
Pneumatocele - Post Traumatic, Loculated Pneumothorax

Imaging Findings:
The patient underwent a chest CT exam in an attempt to better characterize the cystic lesion.

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Imaging Differential Diagnosis:
Pneumatocele - Post Traumatic

Operative Findings:
The patient had the pneumatocele managed medically, rather than surgically, because the patient was a poor surgical risk.

Pathological Findings:

Final Diagnosis:
Pneumatocele - Post Traumatic, Chronic Lung Disease

Follow-up and Prognosis:
The patient did well with medical management.

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