To mark the International Day of Radiology, which this year is focusing on paediatric imaging, we are presenting chest radiographs of a 5-year-old boy with an abdominal mass and mild fever. A Wilm’s tumour was suspected. Check the images below, leave your thoughts in the comments section and come back for the answer on Friday.
Diagnosis.
1. Pleural tumour in fissure
2. Pneumonia
3. Metastases
4. None of the above
Findings: chest radiographs show a rounded pulmonary lesion in the RUL. The indistinct borders, except where contacting with the minor fissure (A-B, red arrows), exclude the diagnosis of tumour or intracisural lesion.
The most likely diagnosis is pneumonia, especially in the presence of fever. Chest radiographs taken ten days later (C-D) confirm the disappearance of the lesion.
Final diagnosis: round pneumonia
My apologies if the diagnosis was too easy, but I didn’t have the heart to give this child (any child) a malignant disease.
Congratulations to all of you who made the right diagnosis, led by Murzin, who was an early starter.
Teaching point: when faced with a round pulmonary lesion in a child, always consider round pneumonia as the first possibility.
Hello,
with this presentation I would suspect round pneumonia- the opacification is outlined by the transverse fissure pleura.
Renal abscesses and infections are pretty common and could be complicated with urosepsis and lung lesions or it could be the other way around.
…polmonite rotonda….
Paediatric round pneumonia.
Limited by the lobe. indistinct margin argues against pleural tumour. Wilms tumour seldom mets to lung.
Round pneumonia
round pneumonia in the middle lobe of right lung (bordered by the minor fissure on the bottom side)
Les avradezco por los cassos clinicos es muy interesantes en el hospital donde trabajo y saludos des de mexico
Muchas gracias por el comentario. Me alegra saber que mi trabajo es útil.
rounded soft tissue mass with ill defined borders in right upper lobe ,.abutting the horizontal fissure
1.could be round pneumonia..abdominal mass could be infected kidney mass or liver abscess
2. could be wilms tumour with pulmonary cannonball metastases
considering the mild fever i would go more in favour of films as septicaemia will cause high grade fever and more debilitated condition of child
sorry wilms tumour not films
At this stage of the game I cannot convince anybody that the child doesn’t have a round pneumonia!
Good for you!
Round pneumonia