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March 1997

Pathological Case of the Month

Author Affiliations

From the Division of Pediatric Pathology, James Whitcomb Riley Hospital for Children and Indiana University School of Medicine, Indianapolis.

Arch Pediatr Adolesc Med. 1997;151(3):317-319. doi:10.1001/archpedi.1997.02170400103020

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

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