Mediastinal mass
Author: Pediatric Oncall
Question.
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.
Answers of this discussion
Author :- HanumanthaRao K.R on 05 May 2013.
Answer :- infected lung cyst or hamartoma or neuroblastoma. leastandlast possibilty of resisrent pnemonia with staph or Tuberculosis

Author :- drshailaja zade on 05 May 2013.
Answer :- Excision of that pseudotumor

Author :- D Nageshcas on 06 May 2013.
Answer :- Hodgikins lymphoma R, o

Author :- drnirmala singh on 06 May 2013.
Answer :- since the tumour is extended upto mediastinum and chestwall so resection cant be done. in this case corticosteroids can be given.

Author :- romondia arturo on 06 May 2013.
Answer :- surgical removal

Author :- Murali Gopal on 06 May 2013.
Answer :- Would a open excision biopsy provide more of histopathological clue of the nature of the tumor_?

Author :- sunil patel on 07 May 2013.
Answer :- may change in antibiotic with chest physiotherapyand nebuliser with muconix{acetyle cystine} be helpful

Author :- iman gamalc on 07 May 2013.
Answer :- antifungal drugs should be tried as well as testing for his cellular immunity

Author :- usman shahc on 07 May 2013.
Answer :- The child should be give a trial of ATT and review X-ray after 4 weeks .

Author :- HITESH ALWADHI on 07 May 2013.
Answer :- THE CHILD SHOULD BE GIVEN A TRIAL OF STEROIDS .IF THE CHILD DOES NOT RESPOND THEN SURGICAL EXCISION IS CURATIVE AS WELL AS REASSURING AS TO THE NATURE OF DISEASE.

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