Pulmonary mass in an infant

Abstract

A Caucasian young female born at term weighing 3.4 kg, presented to her general practitioner at 4 weeks of age and repeatedly after that with cough, fever and “noisy breathing”. She was treated with multiple courses of oral antibiotics. The symptoms persisted, and at 6 months of age a chest radiograph (CXR) showed dense consolidation affecting the right upper lobe. She was admitted to her local hospital for a course of intravenous antibiotics. The patient was afebrile on admission and oxygen saturation was 96% in room air, but she had mild respiratory distress and tachypnoea. Auscultation of the chest revealed scattered crepitations and transmitted sounds. Haematological indices and inflammatory markers were normal. She was an only child, born to unrelated parents who were heavy smokers. Immunisations were up-to-date and she was developing normally. Weight gain was along the 50th centile for the first 6 months but had dropped down towards the 25th centile since weaning had started. There was no other family history of note. After 2 weeks of intravenous antibiotics she remained afebrile but continued to have mild tachypnoea and a cough with persisting CXR changes. A computed tomography scan (CT) of the chest (fig. 1⇓) and flexible bronchoscopy were performed 1 month after initial presentation to the local hospital. Bronchoscopy demonstrated an anatomically normal right upper lobe with partially occluded segmental bronchi. There was no microbial growth from bronchoalveolar lavage. Fig. 1— A contrast enhanced chest computed tomography scan obtained at 7 months of age showing a large mass lesion (arrowheads). A: anterior mediastinum; M: middle mediastinum. At 10 months of age she was referred to a tertiary hospital for children for a surgical opinion and was admitted for an elective excision of the mass. A pre-operative CXR (fig. 2⇓) and magnetic resonance imaging (MRI) of the chest were performed (fig. 3⇓). A right postero-lateral thoracotomy was performed …