Imaging Department

Oct 23rd, 2012 Reported by Dr. Giang

Name: Pham Hong Ngoc Sex: Female Age: 8 months old. Dept: A16

Clinical

High fever: 40*C ( during 3 week, 3 times/ day) Cough & wheeze No dyspnea No seizure

Quang Ninh Hospital ‘s diagnosis: Left Lung Pneumonia Has been treated for 3 days but nothing improved

NHP

Chest x-ray

Opacification of left hemithorax ( upper lobe) Rightward shift of the trachea & mediastinum Left pleural effusion

Pleural pulmonary US

Left Pleural fluid : 10 mm. Solid heterogeneous mass in Left

upper lobe

CT findings(Pre C+)

Large soft tissue mass filling the Left upper lobe. (8x7cm)

Pleural-based Heterogenous density . No calcification or Fat. Pushing heart, trachea & mediastinum to the right

; chest wall to the anterior

CT findings(Pre C+)

Left pleural effusion ( 10mm) Pericardium effusion ( 8mm) Consolidation at both lung hilum

CT findings(Post C+)

Mild heterogenous enhancement Some low density areas with wall enhance ( cysts)

CT findings(Post C+)

Vessel traverse the mass

CT findings(Post C+)

Left superior lobar bronchus: compressed & narrow upper lobe : atelectasis

CT findings(Lung parenchyma Post C+)

Consolidation in both hilum

CT findings(Bone window Post C+)

No chest bone invasion

Lab test

WBC: 23,9 x 10^9. CRP: 48 mg/L

RBC: 3,87 x10^12 HGB: 89 g/L HCT: 0,281 L/L

Diagnosis

Pleuro-pulmonary Blastoma surinfection

(type II)

Top Diffential Diagnosis

1.Rhabdomyosarcoma: Solid mass, invade chest wall.

2.Ewing sarcoma: Invade Rib , extra pleural, not associated with pleural effusion

3.PNET: invade chest wall with similar appearance

4.Pulmonary inflammatory pseudotumor: often contains calcification , smaller then PPB

5.CCAM

Background of PPB1. Definition:

Rare aggressive malignant primary neoplasm of the pleuropulmonary mesenchyme occurring in earlychildhood associated with poor prognosis

2. Location: intra thoracic (100%) ; Pleural-based of intra-parechymal.

3. Size: Large

4. Age: < 5 years old

5. Epidemiology: Very uncommon tumor

Background of PPB6. Pathology: Primitive lung tumor similar to Wilms

tumor, Neuroblastoma & Hepatoblastoma

7. Classification: Type I: Purely cystic ( Good prognosis)

Type II: Cystic and Solid

Type III: Solid ( Worse prognosis)

8. Treatment: : Surgical resection + Chemotherapy

Thank you for attention!