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Virtual Pediatric Hospital: Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease: Case 62 Thoracopaedia: An Imaging Encyclopedia of Pediatric Thoracic Disease

Case 62

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


Chief Complaint:
Four month old male with reactive airways disease.

Clinical History:
The patient was a 4 year old male who was diagnosed with reactive airways disease at 1 month of age. Since then, he had been hospitalized 3 times due to reactive airways disease. Family history was remarkable for 2 sisters with reactive airways disease. His wheezing was worse when awake and was not responsive to steroids or nebulizers. He now presented with respiratory distress and fever.

Clinical Physical Exam:
Febrile, in respiratory distress.

Clinical Labs:
RSV and parainfluenza titers, IgE titers, a Ph probe for gastroesophageal reflux and a sweat test were negative. Pulmonary function tests showed an obstructive picture.

Clinical Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia

Imaging Findings:
A barium swallow was unremarkable (not provided). A V/Q scan showed mild hyperinflation of the lungs, but was otherwise negative (not provided). A chest film showed hyperinflation. A chest CT exam showed scattered ground glass opacities.

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Imaging Differential Diagnosis:
Bronchiolitis obliterans with organizing pneumonia

Operative Findings:
Bronchoscopy was negative for airway foreign body or tracheomalacia. An open lung biopsy of the lingula was performed.

Pathological Findings:
Pathological examination of the surgical specimen revealed bronchiolitis without fibrosis or obliteration and airway stasis. There were no fungus, bacteria, or viruses seen.

Final Diagnosis:
Bronchiolitis Obliterans

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

Similar Cases:
Case 11, Case 63

References:

Title Page


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