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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 13 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 13

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

Chief Complaint:
Twelve year old female with an incidentally noted chest mass

Clinical History:
The patient was a 12 year old female in general good health who developed an upper respiratory infection and had a chest film that demonstrated a right upper lobe cystic mass.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:

Clinical Differential Diagnosis:
Congenital lobar emphysema, cystic adenomatoid malformation, pneumatocele

Imaging Findings:
The outside chest film showed a large, cystic lesion in the right upper lobe. Review of a chest film from infancy (not provided) did not demonstrate an obvious lesion. A chest CT exam performed 13 months after diagnosis better defined the mass. A chest film performed 16 months after diagnosis showed the mass was increasing in size.

icon gificon gifImages 1 and 2

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Imaging Differential Diagnosis:
Cystic adenomatoid malformation, pneumatocele, bulla

Operative Findings:
The lesion was found to be slowly enlarging in size and therefore the patient was taken to the operating room 17 months after diagnosis for elective resection. Through a right thoracotomy the mass was seen to arise from the posterior segment of the right upper lobe. It was excised via a posterior segmentectomy.

Pathological Findings:
Examination of the pathological specimen revealed findings characteristic of a cystic adenomatoid malformation, Type I.

Final Diagnosis:
Cystic Adenomatoid Malformation, Type I

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course.

Similar Cases:
Case 19, Case 53


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