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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 44 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 44

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

Chief Complaint:
Thirteen year old female with a chest mass

Clinical History:
The patient was a 13 year old female who had recently developed fatigue and malaise. Past medical history was remarkable for having had bilateral Wilms tumors at age 6 months, treated by left partial nephrectomy and right total nephrectomy.

Clinical Physical Exam:

Clinical Labs:

Clinical Differential Diagnosis:
Recurrent Wilms tumor

Imaging Findings:
A chest film showed a soft tissue density in the right cardiophrenic angle. A chest CT exam demonstrated that initial mass, and a second one in the azygo-esophageal recess.

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icon gificon gifImages 2 and 3

Imaging Differential Diagnosis:
Metastatic disease

Operative Findings:
The patient underwent a thoracotomy and both lesions were removed.

Pathological Findings:
Pathological examination of the surgical specimen showed both lesions to be metastatic Wilms tumor involving the lung and visceral pleura.

Final Diagnosis:
Metastases, Pulmonary from Wilms Tumor

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

Similar Cases:
Case 43


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