Diagnostic Dilemma

Mediastinal mass

A 4 months old boy presented with fever and cough for 7 days. His chest X-Ray had shown right upper and mid zone consolidation for which he had received ceftriaxone-sulbactum and Amikacin for 7 days but there was no response. He underwent a HRCT chest that showed lobulated mass involving the entire mediastinum with extension to the chest wall on the right side and displacing the lungs suggestive of either a germ cell tumor or a thymoma. A CT guided biopsy was done that showed no identifiable tumor cells and only inflammatory pseudotumour. He was started on antituberculous therapy in view of persistent fever to which there was no response.

What should be done now for this child_?
Expert Opinion :
The child`s fever responded on ATT but the mass continued to remain the same inspite of 3 months of ATT
Answer Discussion :
Manini Moudgal
Consider MRI as it maybe able to delineate the characteristics of the mass better and, or Exploration.
10 years ago
saravanan pal
conngenital malformations like lobar emphysema, cystic malformations to be ruled out.In view of non response to antibiotics fungal,viral and atypical organisms to be ruled out.One may also consider muliple biopsies to avoid missing the tumor if clinical suspicion of malignancy is high.
10 years ago

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