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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 19 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 19

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


Chief Complaint:
Full term newborn male with a chest mass

Clinical History:
The patient was a full term newborn male with a prenatal diagnosis of a cystic chest mass, presumed cystic adenomatoid malformation. Immediately after birth he also clinically appeared to have neonatal pneumonia.

Clinical Physical Exam:
Respiratory distress.

Clinical Labs:
Non-contributory

Clinical Differential Diagnosis:
Cystic adenomatoid malformation, congenital lobar emphysema.

Imaging Findings:
An AP chest film from the first day of life showed an ill defined cystic mass in the left lower lobe. An unenhanced chest CT exam on the first day of life revealed a left lower lobe heterogenous poly lobulated mass that was cystic and partly fluid filled. An AP chest film taken at 10 months of age again showed the left lower lobe cystic chest mass. A repeat unenhanced chest CT exam done at 10 months of age showed multiple cystic lucent areas in the left lower lobe.

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Imaging Differential Diagnosis:
Cystic adenomatoid malformation.

Operative Findings:
A 11 months of life the child was taken to the operating room for an elective resection of the lesion via a left thoracotomy. The lesion was confined to the upper portion of the left lower lobe. The superior segment of the left lower lobe was removed.

Pathological Findings:
The mass was 9.5 x 4 x 1 cm in size. It consisted of multiple cysts, the largest of which was 2.2 cm in diameter. Most of the cysts were 0.1 - 0.2 cm in diameter.

Final Diagnosis:
Cystic Adenomatoid Malformation, Type II

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

Similar Cases:
Case 13, Case 53

References:

Title Page


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