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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 12 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 12

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

Chief Complaint:
Eight year old female with a cough status post bone marrow transplant

Clinical History:
The patient was an 8 year old female status post bone marrow transplant for myelodysplastic syndrome 33 days ago who developed a cough.

Clinical Physical Exam:
Non-productive cough.

Clinical Labs:

Clinical Differential Diagnosis:
Aspergillosis, Pneumocystic Carinii Pneumonia

Imaging Findings:
Chest films demonstrated a lesion in the right lung which was confirmed on a chest CT exam performed 3 days later.

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Imaging Differential Diagnosis:

Operative Findings:
Three days after the chest CT exam the patient underwent a thoracotomy and wedge resection of the right lower lobe to remove the aspergilloma. The lesion was found to be in the apical segment of the right lower lobe.

Pathological Findings:
Pulmonary infarction with cavitation and fungal overgrowth were seen. Angioinvasive septate branching hyphae, consistent with aspergillosis, were also seen.

Final Diagnosis:

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. She was placed on amphotericin and then switched to itraconazole.

Similar Cases:
Case 26, Case 54


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