Intra-abdominal extralobar pulmonary sequestration presenting antenatally as a suprarenal mass

Extralobar pulmonary sequestration is a rare pulmonary parenchymal anomaly which rarely may be present in an intra-abdominal location. The authors report a case of intra-abdominal extralobar pulmonary sequestration which presented to us as an antenatally diagnosed suprarenal mass and was worked up as such. The diagnosis was revealed only at laparotomy. Intra-abdominal extralobar pulmonary sequestration should also be kept in differential diagnosis in cases of masses in the suprarenal location, especially on the left side.     

Intrathoracic ectopic lobe of liver presenting as pulmonary sequestration

Intrathoracic ectopic lobe of the liver in the presence of a normal intact diaphragm is extremely rare. We report a case of a 13-month-old male initially diagnosed with pneumonia and pulmonary sequestration who was found to have an intrathoracic liver lobe and intact diaphragm. The presence of this condition suggests an event preceding closure of the diaphragm and illustrates the unique potential of pediatric pathology to shed light on human embryology.     

Pre- and postnatal treatment of a pulmonary sequestration presenting as a unilateral hydrothorax

We report a case of a neonatal sequestration diagnosed antenatally as a progressive left hydrothorax when ultrasound (US) was done at 30 weeks' gestation for polyhydramnios. Postnatal US and computed tomography failed to demonstrate any lesion; magnetic resonance imaging showed a spherical mass in the left chest adjacent to the left lower lobe. At the age of 4 weeks a thoracotomy was performed and the mass was excised. Pulmonary sequestrations may present with a pleural effusion and polyhydramnios as a part of non-immune hydrops fetalis. In our case hydrops was prevented by insertion of a pleuro-amniotic shunt.     

Posttraumatic internal jugular vein thrombosis presenting as a painful neck mass in a child

An uncommon case of a pediatric traumatic internal jugular vein thrombosis is presented. A 7-year-old boy developed severe neck pain after falling from a bunk bed. Initially, the child was diagnosed and treated for a lymphadenitis with a possible abscess formation. Contrast-enhanced computed tomography and Doppler ultrasound imaging of the neck revealed the presence of an occlusive thrombosis of the left internal jugular vein. The patient was treated with intravenous antibiotics and followed closely over the next year. He had full resolution of his symptoms without the development of complications associated with this injury process. Internal jugular vein thrombosis is an uncommon and potentially life-threatening disorder caused by various conditions. This case illustrates the need for a systematic approach when evaluating neck masses, and internal jugular venous thrombosis should be included in the differential of anterior neck swelling.     

Isolated intrathoracic spleen presenting as an enlarging chest mass

We present the first reported case of an isolated intrathoracic spleen. This presented as an enlarging chest mass in a 6-month-old infant. The lack of symptoms and absence of herniated bowel caused an interesting diagnostic problem which was elegantly solved by a combination of imaging modalities.     

Extralobar pulmonary sequestration presenting with torsion

The current report describes the case of a 13-year-old girl with an extralobar pulmonary sequestration who presented with chest and back pains without evidence of infection. Her symptoms were discovered to be secondary to torsion and infarction of the pulmonary sequestration. Although pulmonary sequestration is not an uncommon differential diagnosis for chest masses, it is rare for it to present in this manner.     

Graves disease presenting as painful thyroiditis

Hyperthyroidism associated with subacute (painful, viral) thyroiditis is well-recognized as a clinical entity; the thyroid gland in Graves disease is minimally, if ever, tender and painful. We describe a 10-year-old girl with hyperthyroidism whose initial clinical presentation was predominantly a painful, tender goiter. Graves disease was established by high uptake of ¹³¹I with a diffuse pattern of distribution of radioactivity on scan and the presence of thyroid-stimulating antibody. Thyrotropin-binding inhibiting IgG and antibody to thyroid microsomal antigen were both positive. She responded well to treatment with propylthiouracil and had spontaneous regression of her thyroid pain. The cause of the severe pain and tenderness remains speculative.Abbreviations PTU propylthiouracil - TSAb thyroid-stimulating antibody This work was supported by the U.S. Public Health Service Grant DK-31391     

Infradiaphragmatic extralobar pulmonary sequestration masquerading as an intra-abdominal, suprarenal mass

Three infants were found to have infradiaphragmatic masses by prenatal ultrasound. Postnatal imaging studies confirmed the presence of these masses, which were suspected of being intra-abdominal malignancies (neuroblastoma). The other principal differential diagnosis was extralobar pulmonary sequestration (EPS). Intraoperative findings were consistent with EPS, which was confirmed by histologic examination. We present these three infants, review the literature, and discuss the evaluation and treatment of infradiaphragmatic EPS.     

Histiocytosis presenting as a nasal mass

The authors present a 1-year-old child who presented with an expansile enhancing mass of the nasal cavity that proved to be histiocytosis.     

Upper thoracic extralobar pulmonary sequestration presenting with respiratory distress in a newborn

An upper thoracic extralobar pulmonary sequestration in a newborn is presented. It was present on the initial chest radiograph taken because of respiratory distress. The sequestration was surgically removed and the infant's respiratory difficulties improved.     

Scurvy presenting as painful gait with bruising in a young boy

A case of scurvy occurred in an apparently well-nourished 5-year-old boy with normal growth parameters. Only after the diagnosis of scurvy was raised on clinical grounds did we discover the peculiar dietary habits that were responsible for his deficiency of ascorbic acid. His case is a reminder to the clinician that nutritionally based disease may occur in any socioeconomic setting and that nutritional screening remains an important part of every child's general health care.     

Management of pulmonary sequestration and scimitar syndrome presenting in infancy

Anomalous systemic arterial supply to the lung, either isolated or in association with partial anomalous pulmonary venous drainage (scimitar syndrome, SS), is uncommon in infancy. Traditionally the management has been surgical, but more recently the technique of arterial embolisation (AE) has been used. We report 11 infants seen over 11 years with anomalous systemic arterial supply to the lung. All patients presented by 10 months of age, 10 with persisting tachypnoea and 1 with pneumonia. Seven had isolated anomalous vascular supply to the lung and 4 associated SS. Six had pulmonary hypertension (PH) at presentation and all of these had associated cardiac defects. Five patients were managed surgically (ligation 3, resection 2) and 5 by AE. All infants managed by AE and 1 of the 3 with ligation have had excellent outcomes; 2 patients with SS had reduction of PH following AE. Three patients with isolated anomalous systemic vascular supply to the lung are now asymptomatic. Two patients with anomalous arterial supply to the lung and significant cardiac lesions had cardiac surgery performed but had persistant cardiac failure. Ligation of the anomalous vessel was then undertaken, but both died. AE is an effective means of initial management of anomalous systemic arterial supply to the lung. It precludes the immediate need for surgery and may lead to control of cardiac failure and PH. In patients with associated cardiac anomalies, AE of the anomalous systemic arterial supply should be considered prior cardiac surgery. Reduction in PH following embolisation of the anomalous systemic arterial connection to the lung occurs in SS, and AE should be considered early in the management of these patients.David Wensley was a Fellow funded by the British Columbia Lung AssociationOffprint requests to: C. F. Robertson     

Splenic cyst presenting as a gastric mass

A 14-year-old girl with bulimia was found to have an apparent submucosal mass of the gastric cardia by upper gastrointestinal series and endoscopy. At laparotomy the mass was found to be a 5 cm in diameter subcapsular serous splenic cyst compressing the stomach but not attached to it. The clinical and diagnostic features of this unusual lesion are reviewed, with particular emphasis on the endoscopic findings.