December 1996

Pathological Case of the Month

Author Affiliations

From the Divisions of Pediatric Pathology (Drs Davis and Heifetz) and Pediatric Radiology (Dr Bugaieski), James Whitcomb Riley Hospital for Children and Indiana University School of Medicine, Indianapolis, Ind.

Arch Pediatr Adolesc Med. 1996;150(12):1309-1310. doi:10.1001/archpedi.1996.02170370087016

A GROWTH-RETARDED male neonate was born at 30 weeks of gestation by emergency cesarean section for partial abruption and fetal distress. His birth weight was 840 g. The Apgar scores were 3 and 4 at 1 and 5 minutes, respectively, and he required intubation and mechanically assisted ventilation for 10 days for uncomplicated hyaline membrane disease. With clinical improvement, a plain chest radiograph (Figure 1) showed resolving hyaline membrane disease and what was interpreted as focal right upper lobe (of the lung) atelectasis or infiltrate.

At age 17 months, he was seen by his local pediatrician with a 2½-month history of persistent nonproductive cough. A chest X-ray film revealed a right upper lobe infiltrate that did not resolve with antibiotic therapy. A chest computed tomographic scan with and without contrast medium (Figure 2 and Figure 3) showed a 2.2-cm pulmonary parenchymal right upper lobe nodule with enhancement and large feeding

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