Wednesday, February 1, 2017

A 3 Year Old Child With A Mass On The Chest

A 3 years old child was seen by the pediatrician for a large soft tissue mass on right side of chest.

Photograph (A) of the child shows the soft mass (arrow), on X-ray chest (B) the soft tissue lymph nodal mass lies outside the thoracic cage in right hemithorax.

Diagnosis: Lymph node mass.

Discussion: On X-ray chest the lung fields are clear, on X-ray chest it is important to look for any lesion in the soft tissue over the entire available film. It may be in the form of enlarged thyroid gland, cervical or axillary lymph nodes, neurofibroma, surgical emphysema, a lesion in the breast or one
of the breasts might have been surgically excised. Ultrasound can be useful in investigating nodal masses particularly as an aid to biopsy.

CT is generally the method of choice, providing a direct and reproducible demonstration of normal and abnormal lymph nodes. MRI has potential to replace CT in the assessment of nodal disease, although at higher cost, MRI is the option during follow-up of nodal disease being radiation free.

Lymph node enlargement is the hallmark of metastatic disease keeping in mind the size criteria for normal and abnormal lymph nodes have evolved in the different areas of the body.

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