SHM Converge Scientific Abstract ePoster Gallery-The Adolescent Who Cried Chest Pain: A Curious Chest Mass

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A 17-year-old female presented with hemoptysis and chest pain after laughing, during which she coughed up about half a cup of dark red blood. Her chest pain was central and right-sided, with associated anxiety and palpitations. Three months earlier, she had been treated for presumed pneumonia after imaging at an outside ED.<br /><br />Initial workup was unrevealing for common causes of chest pain and hemoptysis: d-dimer, EKG, TB testing, serum hCG, AFP, and LDH were negative. Chest X-ray showed a round ground-glass opacity near the right inferior hilum. CT chest with contrast revealed a complex right pericardial cyst measuring 3.0 x 2.4 x 6.0 cm extending into the right middle lobe. Echocardiogram showed an extracardiac mass lateral to the right atrium that moved with the atrium.<br /><br />Because of concern for a mediastinal mass, pediatric surgery and cardiothoracic surgery were consulted and the lesion was resected. Gross pathology suggested a dermoid cyst, and final pathology showed a 5.7 cm mature cystic teratoma with a teratoma-bronchiolar fistula. Hemoptysis was thought to be due to post-obstructive pneumonitis or lesion rupture.<br /><br />The patient remained in the PICU for 2 days with telemetry while a pericardial drain was in place, then was transferred to the floor for pain control and discharged home.<br /><br />This case highlights that hemoptysis in adolescents has a broad differential, including infection, cardiac disease, vascular disorders, trauma, tumors, medications, and toxins. Although respiratory infection is the most common cause, persistent or recurrent symptoms warrant further imaging and specialist evaluation. The case emphasizes the importance of maintaining a broad, unbiased differential diagnosis in adolescents with chest pain and hemoptysis.

Asset Subtitle

Andrea Lafnitzegger

Meta Tag

Author List Andrea Lafnitzegger, Camille Carre

Category Clinical Vignettes

Concept Hemoptysis

Concept Chest Pain

Concept Differential Diagnosis

Concept Anterior Mediastinal Mass

Concept Mature Cystic Teratoma

Distinguished Non-Finalist

Presenter Organization University of South Florida Morsani College of Medicine

Presenting Author Andrea Lafnitzegger

Track Pediatric

Keywords

hemoptysis

chest pain

adolescent

pericardial cyst

mediastinal mass

mature cystic teratoma

bronchiolar fistula

CT chest

pediatric surgery

differential diagnosis

Hemoptysis

Chest Pain

Differential Diagnosis

Anterior Mediastinal Mass

Mature Cystic Teratoma