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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 55 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 55

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

Chief Complaint:
Fifteen year old female with a non-productive cough

Clinical History:
The patient was a 15 year old female who at the age of 12 years old had cysts incidentally noted in her lungs on a chest film. One month ago, she developed symptoms including a dry, non-productive cough. The patient did not have a history of foreign travel or a history of unusual exposures.

Clinical Physical Exam:

Clinical Labs:
A sweat test was negative.

Clinical Differential Diagnosis:

Imaging Findings:
A chest film demonstrated multiple, variably sized cystic lesions in both lungs. These were better characterized on a chest CT exam. Abdomen CT exam (not provided) was unremarkable.

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Imaging Differential Diagnosis:
Fungal / granulomatous / indolent bacterial infection, atypical metastatic disease, cystic fibrosis, eosinophilic granuloma.

Operative Findings:
A bronchoscopy was performed and failed to reveal any papillomas in the airways. An open lung biopsy was then performed.

Pathological Findings:
Pathological examination of the surgical specimen revealed the presence of bronchoalveolar carcinoma.

Final Diagnosis:
Bronchoalveolar Carcinoma

Follow-up and Prognosis:
The patient had an uncomplicated post-operative course. It was decided not to treat the patient until she became severely symptomatic as the tumor is usually slow growing and the chemotherapeutic agent is quite toxic.

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