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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 10 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 10

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

Chief Complaint:
One month old male with respiratory distress.

Clinical History:
The patient was a 1 month old male who was noted to have increased respiratory rates and contractions.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:

Clinical Differential Diagnosis:
Infection versus lung lesion.

Imaging Findings:
Nuclear medicine, chest CT exam, and chest films showed a lesion in the right lung.

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Imaging Differential Diagnosis:
Congenital lobar emphysema versus cystic adenomatoid malformation

Operative Findings:
Two weeks after the chest CT exam the patient had an elective thoracotomy. The right middle lobe was emphysematous and a right middle lobectomy was performed.

Pathological Findings:
The mass was 10 x 7 x 3 cm in size. Dysplastic lung parenchyma with emphysematous changes consistent with lobar emphysema and features of polyalveolar lobe were found. Pathological Diagnosis: Congenital Lobar Emphysema, Right Middle Lobe

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. A routine chest film obtained two months postoperatively suggested a right upper quadrant calcification, and an ultrasound was performed to rule out neuroblastoma and was negative.

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