Michael P. D'Alessandro, M.D.
Peer Review Status: Internally Peer Reviewed
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.
White blood count of 14.9 with 49% polymorphic neutrophils
Clinical Differential Diagnosis:
Lipoma, osteomyelitis, sarcoma
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.
Images 2 and 3
Images 4 and 5
Imaging Differential Diagnosis:
Fibrosarcoma, rhabdosarcoma, primitive neuroectodermal tumor, metastatic disease, lymphoma, infection
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.
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.
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.
Case 15, Case 18, Case 46, Case 67, Case 68, Case 69
Please send us comments by filling out our Comment Form.
All contents copyright © 1992-2013 Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. and the authors. All rights reserved.
"Virtual Pediatric Hospital", the Virtual Pediatric Hospital logo, and "A digital library of pediatric information" are all Trademarks of Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.
Virtual Pediatric Hospital is funded in whole by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D. Advertising is not accepted.
Your personal information remains confidential and is not sold, leased, or given to any third party be they reliable or not.
The information contained in Virtual Pediatric Hospital is not a substitute for the medical care and advice of your physician. There may be variations in treatment that your physician may recommend based on individual facts and circumstances.
This site complies with the HONcode standard for trustworthy health information: