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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 27 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 27

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

Chief Complaint:
Seven week old male with a chest wall mass.

Clinical History:
The patient was a 7 week old male with severe eczema whose parents had noticed an enlarging soft tissue mass on the left thorax for one week.

Clinical Physical Exam:
Palpable, ill defined soft tissue mass along the left hemithorax.

Clinical Labs:
White blood count of 14.9 with 49% polymorphic neutrophils

Clinical Differential Diagnosis:
Lipoma, osteomyelitis, sarcoma

Imaging Findings:
AP chest film from the day of admission showed a soft tissue mass projecting along the left lateral aspect of the lower thorax / upper abdomen with associated bony destruction of the 8-10th ribs with periosteal new bone formation. Unenhanced chest CT exam and MRI exam from the second hospital day better delineated the findings.

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Imaging Differential Diagnosis:
Fibrosarcoma, rhabdosarcoma, primitive neuroectodermal tumor, metastatic disease, lymphoma, infection

Operative Findings:
On the 5th hospital day the patient underwent a left chest wall biopsy in the operating room. Purulent material was returned from the necrotic center of the mass. A frozen section was negative for malignant cells.

Pathological Findings:
Pathologic examination of the specimen revealed an organizing abscess with numerous bacterial cocci. There was no evidence of granulomas, tumor, or Langerhans cell Histiocytosis. Abundant staphylococcus and moderate Klebsiella were grown out. No malignant cells were seen.

Final Diagnosis:
Osteomyelitis, Chest Wall

Follow-up and Prognosis:
It was felt the likely cause of the abscess was an open lesion from the patient's severe eczema.

Similar Cases:
Case 15, Case 18, Case 46, Case 67, Case 68, Case 69


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