Case 3: Chest Wall Swelling in a Late Preterm, Immunocompetent Neonate

Abstract

Our index case is a late preterm (36-week), male neonate with a birth weight of 2.6 kg who was born to an older, primigravida (age, 42 years) mother by normal vaginal delivery and was discharged from the hospital on day 6 after birth after an uneventful hospital course. The infant was readmitted on day 21 after birth for the evaluation of incidentally detected left chest wall swelling by the mother for the past 2 days before admission. There was no history of fever, irritability, lethargy, poor feeding, fast breathing, or trauma to the chest. Examination revealed a nonerythematous, nontender, soft swelling of 6 × 5 × 5 cm that involved the left upper lateral chest wall and extended toward the axilla and back. Because the neonate had a clinical lesion that involved the left side of chest wall and axilla and there was history of BCG vaccination at birth on the same arm, a differential diagnosis of BCG adenitis was made. In addition, we also considered a possible primitive neuroectodermal tumor or Ewing tumor as a differential diagnosis. However, the neonate did not have any other systemic features (fever, skin bruising, or weight loss) to suggest a primitive neuroectodermal tumor. Radiography suggested involvement of the underlying rib with no specific periosteal reaction (onion skin–type periosteal reaction in Ewing sarcoma). The fine-needle aspiration cytologic test result was negative for mycobacterium and malignant cells. Contrast enhanced computed tomography …