Assembly

All Good Things Must Come to an End

share Share

Authors
Swati Jayaram, Lisa Ulrich, Melissa Holtzlander
Department of Pediatric Pulmonology, Nationwide Children’s Hospital, Columbus, Ohio


Case

An 11 yo male with history of autism was seen in the emergency department for complaints of nausea, vomiting and a 30 lb weight loss over the past 2 months. Chest CT imaging was obtained by the emergency department for suspicion of malignancy. He was referred to the pulmonary clinic for significant CT imaging findings (Figure 1). Patient had chronic cough and shortness of breath for approximately 1 year, for which he was prescribed albuterol without a spacer. There were no prior episodes of pneumonia. Family history was significant for asthma. On examination there was no digital clubbing noted and auscultation revealed good aeration bilaterally without any adventious sounds. He was discharged with instructions to use albuterol with spacer and plans for combined endoscopy with both flexible bronchoscopy and GI endoscopy. On EGD, pyloric stricture was noted and dilated. Flexible bronchoscopy revealed the following findings in the lateral segment of right lower lobe (Figure 2).

Figure 1: Axial segments of Chest CT
Figure 1: Axial segments of Chest CT
Figure 2: Image of flexible bronchoscopy showing all the segments of right lower lobe
Figure 2: Image of flexible bronchoscopy showing all the segments of right lower lobe

Question

What is the diagnosis?

A. Congenital pulmonary airway malformation
B. Bronchial atresia
C. Pulmonary sequestration
D. Mucoid impaction

Answer