Pediatr Nephrol DOI 10.1007/s00467-015-3054-1
CLINICAL QUIZ
A newborn infant with intrathoracic mass: Questions Serdar Alan & Omer Erdeve & Duran Yildiz & Dilek Kahvecioglu & Begum Atasay & Saadet Arsan
Received: 31 December 2014 / Revised: 12 January 2015 / Accepted: 12 January 2015 # IPNA 2015
Keywords Intrathoracic mass . Newborn . Bronchiolitis
Case presentation A 3,430-g male term newborn was delivered spontaneously to a 25-year-old mother after an uneventful pregnancy and discharged 1 day after birth. The newborn presented with cough and respiratory insufficiency on postnatal day 12, concurrently with upper respiratory tract infection of his older brother. The patient’s physical examination on admission was normal except for wheezing and desaturation. His chest radiograph revealed para-cardiac consolidation (Fig. 1a), and he was
The answers to these questions can be found at http://dx.doi.org/10. 1007/s00467-015-3055-0. S. Alan (*) Neonatal Intensive Care Unit, Hitit University Corum Training and Research Hospital, Corum, Turkey e-mail: [email protected] O. Erdeve : D. Yildiz : D. Kahvecioglu : B. Atasay : S. Arsan Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine Children’s Hospital, Ankara, Turkey
admitted to the neonatal intensive care unit (NICU) where he received inhaler salbutamol, oxygen and antibiotic therapy for 10 days. His respiratory signs completely disappeared, but as the consolidate lesion which was observed in the posterior mediastinal region on the right lateral decubitus chest radiography was still present (Fig. 1b) the patient was referred to Level 3 NICU for further evaluation. His physical examination was normal [weight 4,210 g (50th percentile), length 52 cm (25th percentile), head circumference 37 cm (50th percentile) on postnatal day 22], except for diminished ventilation on right lower chest on admission. The blood gas analysis and complete blood count were within normal ranges. Biochemical evaluation for renal and liver function were all normal [Na 139 (normal range 136–146 mEq/L),
Pediatr Nephrol
Fig. 1 a Postero-anterior chest radiograph of the infant showing right para-cardiac consolidation (arrow). b Resistant consolidate lesion in posterior mediastinal region on right lateral decubitus chest radiography after medical treatment (arrow)
K 4.4 (normal range 3.5–5.1 mEq/L), blood urea nitrogen 6 (normal range 7–18) mg/dL, creatinine level of 0.18 (normal range 0.6–1.3) mg/dL]. Urine output was measured as 3 mL/kg/h. Echocardiography revealed normal cardiac structure.
Questions 1. What could the abnormal area in the lung be? 2. How could this intrathoracic mass be investigated? 3. What type of other associated anomalies should be considered?
CLINICAL QUIZ
A newborn infant with intrathoracic mass: Questions Serdar Alan & Omer Erdeve & Duran Yildiz & Dilek Kahvecioglu & Begum Atasay & Saadet Arsan
Received: 31 December 2014 / Revised: 12 January 2015 / Accepted: 12 January 2015 # IPNA 2015
Keywords Intrathoracic mass . Newborn . Bronchiolitis
Case presentation A 3,430-g male term newborn was delivered spontaneously to a 25-year-old mother after an uneventful pregnancy and discharged 1 day after birth. The newborn presented with cough and respiratory insufficiency on postnatal day 12, concurrently with upper respiratory tract infection of his older brother. The patient’s physical examination on admission was normal except for wheezing and desaturation. His chest radiograph revealed para-cardiac consolidation (Fig. 1a), and he was
The answers to these questions can be found at http://dx.doi.org/10. 1007/s00467-015-3055-0. S. Alan (*) Neonatal Intensive Care Unit, Hitit University Corum Training and Research Hospital, Corum, Turkey e-mail: [email protected] O. Erdeve : D. Yildiz : D. Kahvecioglu : B. Atasay : S. Arsan Division of Neonatology, Department of Pediatrics, Ankara University School of Medicine Children’s Hospital, Ankara, Turkey
admitted to the neonatal intensive care unit (NICU) where he received inhaler salbutamol, oxygen and antibiotic therapy for 10 days. His respiratory signs completely disappeared, but as the consolidate lesion which was observed in the posterior mediastinal region on the right lateral decubitus chest radiography was still present (Fig. 1b) the patient was referred to Level 3 NICU for further evaluation. His physical examination was normal [weight 4,210 g (50th percentile), length 52 cm (25th percentile), head circumference 37 cm (50th percentile) on postnatal day 22], except for diminished ventilation on right lower chest on admission. The blood gas analysis and complete blood count were within normal ranges. Biochemical evaluation for renal and liver function were all normal [Na 139 (normal range 136–146 mEq/L),
Pediatr Nephrol
Fig. 1 a Postero-anterior chest radiograph of the infant showing right para-cardiac consolidation (arrow). b Resistant consolidate lesion in posterior mediastinal region on right lateral decubitus chest radiography after medical treatment (arrow)
K 4.4 (normal range 3.5–5.1 mEq/L), blood urea nitrogen 6 (normal range 7–18) mg/dL, creatinine level of 0.18 (normal range 0.6–1.3) mg/dL]. Urine output was measured as 3 mL/kg/h. Echocardiography revealed normal cardiac structure.
Questions 1. What could the abnormal area in the lung be? 2. How could this intrathoracic mass be investigated? 3. What type of other associated anomalies should be considered?
