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J Thorac Cardiovasc Surg 2004;128:319-322
© 2004 The American Association for Thoracic Surgery

Clinical-pathologic conference

Clinical-pathologic conference in general thoracic surgery: Pulmonary artery fibrohistiocytic tumor in a child

^a Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany

Received for publication October 3, 2003; revisions received November 3, 2003; accepted for publication November 11, 2003.

^* Address for reprints: Paolo Macchiarini, MD, PhD, Department of Thoracic and Vascular Surgery, Heidehaus Hospital (Hannover Medical School), Am Leineufer 70, 30419 Hannover, Germany
pmacchiarini@compuserve.com

The first 300 words of the full text of this article appear below.

	Case presentation

 
Dr Walles
The patient was a 10-year-old boy weighing 29.1 kg (50th percentile) and was 160.5 cm (50-75th percentile) tall. He was complaining of night sweats, inspiratory pain located under the right costal arches and radiating to the right shoulder, and progressive exhaustion, exertional dyspnea, and weight loss for 1 month. His medical history was unremarkable, and there was no evidence of tuberculosis exposition or tumor disease in his family records. On an outpatient basis, an initial diagnosis of exertional bronchospastic obstruction was made, and he was given bronchodilator inhaled agents without success. Because of this, a plain chest radiograph was made showing a shadow in the right upper thoracic cavity, interpreted initially as pleuritis. To further clarify the diagnosis, a computed tomograph (CT) of the chest was made that showed a tumor mass located in the right hilus, with enlarged lymph nodes in the ipsilateral upper mediastinum. A nuclear magnetic resonance image ruled out additional abdominal masses or lymph nodes. Perhaps at this point we could have the pediatric pneumologist present the findings of the patient at hospital admittance.

Dr freihorst
On admission the patient showed slight congestion of the superficial veins over the chest and abdomen. He was a little tachypneic, with mild intercostal retractions, but had no cyanosis, and breath sounds were vesicular, with minimal wheezing over the right lung. Physical examination was unremarkable otherwise. A sonogram of the neck showed enlarged lymph nodes at the right prescalenic area, and one of them was surgically resected for histologic diagnosis. Serum ß-human chorionic gonadotropin hormone and -fetoprotein markers and urinary levels of catecholamine were normal. Fiberoptic bronchoscopy showed slight inflammation of the right upper lobe takeoff but no endoluminal tumor or other significant abnormalities, and a bronchoalveolar lavage and a transbronchial biopsy of the enlarged right paratracheal lymph nodes were performed.

Dr Kreipe
The . . . [Full Text of this Article]