A 3-YEAR-OLD girl had a history of recurrent cough, fever (up to 38.8°C), dyspnea, and weight loss since age 15 months and a family history of tuberculosis. An intradermal tuberculin test (purified protein derivative) had positive results (15 × 15-mm induration). Findings from chest radiograph (Figure 1) revealed a nonhomogeneous pulmonary opacity with irregular borders on the right lower lobe that did not resolve with antituberculous therapy over 1 year. On examination, she had an asymmetrical thorax and minimal intercostal retractions. Breath sounds were decreased over the right lower lobe. Immunoglobulin levels, nitroblue tetrazolium reduction test results, and sweat chloride concentration were within the reference range. Thoracic computed tomography with contrast medium revealed multiple cystic lesions in the right lower lobe, infiltration of the lower lobe, and increase in right lung volume (Figure 2). No foreign body substance was found on bronchoscopy. A right lower lobe superior segmentectomy via thoracotomy was performed. There was no systemic arterial supply to the lesion, excluding intralobar sequestration. The resected lung had a cystic mass (4.0 × 3.5 × 1.5 cm) (Figure 3 and Figure 4). One year after surgical resection, the chest radiograph appeared normal (Figure 5).
Taştan Y. Pathological Case of the Month. Arch Pediatr Adolesc Med. 2000;154(6):633. doi:10.1001/archpedi.154.6.633