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Opacity on Left Side of Chest: Pandora of Differentials for a Pediatrician


Opacity on Left Side of Chest: Pandora of Differentials for a Pediatrician
Figure 1. Chest radiograph of child showing large homogenous opacity on left side Figure 2. CT chest showing homogenous mass in anterior mediastinum

Reena Jain, Pankaj Kumar, Shivani Randev, Vishal Guglani
Question:
A six-month old male infant presented with first episode of cough for one day without fever. He was active, feeding well and playful. On examination, he had tachypnea (respiratory rate was 66/min), subcostal retractions and bilateral diffuse wheeze. Clinical diagnosis of acute bronchiolitis was made, and child was treated symptomatically with oxygen and nebulization with hypertonic saline for 2 days. Complete blood count, C-reactive protein were normal, while chest X-ray showed diffuse opacity on left side (Figure 1). A possibility of congenital lung malformation or enlarged thymus or cyst was kept. CT chest showed a well-defined, soft tissue density, homogenous mass in anterior mediastinum (Figure 2) measuring 3.6x5.3x5.1 cm and was not causing any compression of bronchovascular structures.
What is the diagnosis?

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