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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 54 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 54

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

Chief Complaint:
Fifteen year old male with ALL and a fever

Clinical History:
The patient was a 15 year old male with ALL, who had failed chemotherapy induction 3 times, who developed a fever. He was started on Gentamicin and Methicillin. Chest films at this time were negative. Eight days after the onset of fever a chest film became positive.

Clinical Physical Exam:

Clinical Labs:
The WBC count was 230/cubic millimeter.

Clinical Differential Diagnosis:
Lung infection

Imaging Findings:
Chest film taken 8 days after the fever began demonstrated a new right middle lobe opacity. A chest CT exam from 13 days after the fever began showed bilateral lung lesions.

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Imaging Differential Diagnosis:

Operative Findings:
The patient was started on Amphotericin. A needle aspiration of one of the upper lobe lesions was performed.

Pathological Findings:
Pathological examination of the biopsy specimen revealed the presence of Aspergillosis.

Final Diagnosis:

Follow-up and Prognosis:
The patient's WBC count increased to 3,000. Chest films and chest CT exams began to show cavitation of the lesions.

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Similar Cases:
Case 12, Case 26


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