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April 1997

Radiological Case of the Month

Author Affiliations

From the Respiratory Unit, Great Ormond Street Hospital for Children National Health Service Trust, London, England.

Arch Pediatr Adolesc Med. 1997;151(4):423-424. doi:10.1001/archpedi.1997.02170410097014

A 7-YEAR-OLD boy had been examined regularly since birth because of maternal varicella zoster during his third month of gestation. Many clinical features documented during his first year of life were attributed to congenital varicella zoster, namely, a left preganglionic Horner syndrome, growth failure, and pharyngeal reflux in coordination with severe gastroesophageal reflux. No pulmonary changes were noted on chest radiograph in infancy.

At 1 year of age he required a Nissen fundoplication and commenced gastrostomy feeding. Despite this intervention he continued to be troubled by vomiting and frequent attacks of pneumonia. Growth proceeded along the third percentile for age.

At 7 years of age firm posterior triangle cervical lymphadenopathy and digital clubbing developed. He had no pulmonary symptoms. Skin testing for tuberculosis was negative. Radiographs (Figure 1) and a computed tomographic scan (Figure 2) of the chest are shown. A histological diagnosis was made following a transbronchial biopsy.