#radcases

Here's a companion case to yesterday's. This is a neonate with respiratory distress.

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The right mid to lower lung is hyperinflated. There is leftward medisastinal shift, including prominent medisatinal fat (that's not a mass in the left lung). CT shows cystic expansion of the right lung (2nd image). This is a congenital pulmonary airway malformation (CPAM) formerly known as congenital cystic airway malformation (CCAM). CPAM is a multicystic mass with abnormal bronchial proliferation. Differential diagnosis includes pulmonary sequestration, congenital lobar overinflation, and bronchogenic cyst (usually not aerated).

This is an 11-year-old girl with several months of right chest pain.

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This case is your reminder that not all important chest x-ray findings are in the heart and lungs. There is a mixed lytic/sclerotic lesion in the right lateral 10th rib. At CT this was shown to be an expansile mass with a large soft tissue component. In a patient of this age, you should be thinking sarcoma, and this was indeed Ewing sarcoma.

This is a case of a 7 year-old boy who presented with vomiting, diarrhea, and shortness of breath.

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There is a right lung mass or consolidation with irregular margins, and an adjacent airspace opacity. History and location of the finding are strongly suggestive of round pneumonia. Imaging follow-up is not required but this can be done 30 days after treatment if needed. In this patient, follow-up chest radiograph after 6 weeks was clear.