SHM Converge Scientific Abstract ePoster Gallery-When Pneumonia Is More Than Pneumonia

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A 10-month-old boy with a prior history of pneumonia presented with fever, cough, and respiratory distress. He was tachypneic and hypoxic, with markedly decreased breath sounds and crackles over the entire left lung. Laboratory studies showed significant inflammation, including leukocytosis with bandemia, elevated CRP, and very high procalcitonin, so he was initially treated as severe pneumonia with supplemental oxygen and IV ampicillin.<br /><br />Because prior chest x-rays showed persistent mediastinal shift and left lung opacification, further imaging was obtained. Chest CT revealed a thin-walled 3.2 × 2.3 cm posterior mediastinal cystic mass between the trachea and spine causing complete obstruction of the left mainstem bronchus. This led to left lung atelectasis and hyperinflation of the right lung. Cardiothoracic surgery was consulted, and the patient underwent right thoracotomy with mass resection.<br /><br />Pathology confirmed an esophageal duplication cyst. This case highlights that recurrent or nonresolving “pneumonia” in children may actually reflect an underlying congenital lesion rather than infection alone. Esophageal duplication cysts are rare, more common in boys, and usually present before age 2 with respiratory symptoms, dysphagia, or recurrent pneumonia. Surgical resection is the definitive treatment.<br /><br />The child recovered well, was discharged on postoperative day three, and follow-up chest x-ray one month later showed complete resolution of the lung opacification.

Asset Subtitle

Taylor Hartlaub

Meta Tag

Author List Cornelius Braam, Elizabeth Grogan, Sean Ankrom, Taylor Hartlaub

Category Clinical Vignettes

Concept Pneumonia

Concept Esophageal Duplication Cyst

Concept Structural Lesion

Concept Posterior Mediastinal Cystic Mass

Concept Bronchus Occlusion

Distinguished Non-Finalist

Presenter Organization Nationwide Children's Hospital

Presenting Author Taylor Hartlaub

Track Pediatric

Keywords

esophageal duplication cyst

pediatric pneumonia

mediastinal mass

left mainstem bronchus obstruction

lung atelectasis

respiratory distress

thoracotomy

congenital lesion

recurrent pneumonia

surgical resection

Pneumonia

Esophageal Duplication Cyst

Structural Lesion

Posterior Mediastinal Cystic Mass

Bronchus Occlusion