SRP Discussion
Overview
Two cases were discussed: (Case 1) a nearly 4-year-old girl with recurrent pneumonias and a possible bicuspid aortic valve and a large posterior mediastinal tumor; and (Case 2) the diagnosis and treatment of chylothorax, a condition where lymphatic fluid accumulates in the chest, and the use of interventional radiology-guided embolization as a treatment option. Additionally, discussions covered a successful procedure to block a leak in a patient, which involved going retrograde from the subclavian vein into the thoracic duct.
Case 1. 3-year-old Female Presents with Incidental Finding on CXR after Recurrent Pneumonia
Case 1 described a well-defined, heterogeneous mass with neural foramina extension, likely a neurogenic tumor. The mass was confirmed to be a neural crest tumor by MIBG imaging. The differential diagnosis included neural crest tumors, gangliomas, neuroblastomas, and nerve sheath tumors. The patient's age and the mass's characteristics suggested a diagnosis of neuroblastoma or ganglioneuroblastoma. The team considered the possibility of observing the tumor, but noted that the size of the tumor and its compression of the lung would not qualify for observation under current protocols.
Case 2. 17-year-old Male Presents to Emergency Room with Shortness of Breath
Case 2 described a male patient with shortness of breath. The radiologist was asked to interpret the chest X-ray, which showed a complete whiteout of the right chest with tracheal deviation to the left side, suggesting a pathology on the right side. The team agreed to further characterize the pathology with additional tests.