Introduction. The main causes of chest masses in paediatrics are rounded pneumonia (particularly in patients less than 8 years old), bronchogenic cyst, and neuroblastoma. Proper evaluation of the patient record, clinical follow-up, and imaging procedures will allow us to reach a correct diagnosis. Clinical observation. Two cases presented, one 5 and one 3-yearold boy, who in the context of fever and hypophonesis received a chest x-ray. The first case was 5-year-old boy with anaemia and fever, which did not improve with antibiotic treatment with amoxicillin-clavulanic acid. The chest x-ray showed a right pulmonary mass suggestive of a tumour process. After a chest ultrasound (US) and computed tomography (CT), final diagnosis was consistent with complicated pneumonia, treated henceforth with antibiotic and thoracocentesis. The second case was a 3-year-old boy with a clinical-radiological diagnosis of pneumonia persisting with fever, despite antibiotic therapy for a week. A neoplasm was assessed after chest US and CT and surgical biopsy disclosed endodermal sinus tumour. Comments. The association of fever and respiratory symptoms with the x-ray findings may suggest pneumonia, but once the adequate antibiotic treatment has been established, persistence of clinical symptoms and radiological abnormality, should lead us to reconsider the initial diagnosis. Although the role of plain film is evident, in both presented cases the clinical follow-up, as well as chest US and CT, were fundamental for the correct diagnosis.
|Publication status||Published - 1 Jan 2009|
- Differential diagnosis
- Mediastinal neoplasms