A 12-YEAR-OLD white girl was seen with a 2-week history of productive cough and hemoptysis. Her family history and medical history were noncontributory.
The results of physical examination were unremarkable except for decreased breath sounds bilaterally and a palpable liver 4 cm below the right costal margin. A chest x-ray film revealed cardiomegaly and bilateral diffuse nodules, some of which appeared cavitary (Figure 1). The patient's hemoglobin level was 91 g/L and her hematocrit was 0.26, with a mean corpuscular volume of 83 fL. The findings of coagulation studies, a serum chemistry profile including liver function tests, and rheumatologic tests were all normal. The sputum tested negative for acid-fast bacilli, and blood and urine cultures were negative for organisms. No granulomas were identified with bronchoscopy.
Echocardiography disclosed a pericardial effusion. A pericardial window was performed and revealed a hemorrhagic effusion. Biopsy specimens of the lung nodules were obtained (Figures 2
Roepke JE, Heifetz SA. Pathological Case of the Month. Arch Pediatr Adolesc Med. 1997;151(3):317-319. doi:10.1001/archpedi.1997.02170400103020