- Case report
- Open Access
Unusual presentations of lung lesions in children: difficult to diagnose case series
Egyptian Journal of Bronchology volume 10, pages 212–222 (2016)
We present five cases of unusual and rare presentations of different congenital/acquired lung lesions. These cases were encountered during our daily practice. They were misdiagnosed initially and received wrong treatment. There were challenges encountered during the diagnosis and the management of these patients, which required different modalities, ranging from chest radiography, computed tomography to surgical exploration and biopsy, to reach the final diagnosis. These cases range from one absent lung, bilateral intralobar pulmonary sequestrations, bronchogenic cyst, congenital right diaphragmatic hernia to cystic hydatidosis (hydatid cyst). There should be a high index of suspicion when the patient has an abnormal/atypical presentation, a prolonged course of the disease or abnormal imaging. Healthcare providers should also think of rare chest diseases and refer such patients to a paediatric specialist (pulmonologist) to help in the final diagnosis and specific management, which may require invasive procedures or specific imaging.
Zedan M, Elgamal MA, Zalata K, Nasef N, Fouda A. Progressive stridor: could it be a congenital cystic lung disease? Acta Paediatr 2009; 98:1533–1536.
Zur KB, Litman RS. Pediatric airway foreign body retrieval: surgical and anesthetic perspectives. Paediatr Anaesth 2009; 19:109–117
Fitzpatrick PC, Guarisco JL. Pediatric airway foreign bodies. J La State Med Soc 1998; 150:138–141.
Lima JA, Fischer GB. Foreign body aspiration in children. Paediatr Respir Rev 2002; 3:303–307.
Applegate KE, Dardinger JT, Lieber ML, Herts BR, Davros WJ, Obuchowski NA, Maneker A. Spiral CT scanning technique in the detection of aspiration of LEGO foreign bodies. Pediatr Radiol 2001; 31:836–840.
Kisku KH, Panigrahi MK, Sudhakar R, Nagarajan A, Ravikumar R, Daniel JR. Agenesis of lung − a report of two cases. Lung India 2008; 25:28–30.
Sbokos CG, McMillan IK. Agenesis of the lung. Br J Dis Chest 1977; 71:183–197.
Stern R, Berger S, Casaulta C, Raio L, Abderhalden S, Zachariou Z. Bilateral intralobar pulmonary sequestration in a newborn, case report and review of the literature on bilateral pulmonary sequestrations. J Pediatr Surg 2007; 42:E19–E23.
Couriel J. Assessment of the child with recurrent chest infections. Br Med Bull 2002; 61:115–132.
Panitch HB. Evaluation of recurrent pneumonia. Pediatr Infect Dis J 2005; 24:265–266.
Zach MS, Eber E. Adult outcome of congenital lower respiratory tract malformations. Thorax 2001; 56:65–72.
Hashemzadeh S, Aslanabadi S, Jafari Rouhi AH, Azhough R, Kaleibar NA. Congenital malformations of the lung. Indian J Pediatr 2007; 74:192–194.
Horak E, Bodner J, Gassner I, Schmid T, Simma B, Grässl G, Sawyer SM. Congenital cystic lung disease: diagnostic and therapeutic considerations. Clin Pediatr (Phila) 2003; 42:251–261.
Williams HJ, Johnson KJ. Imaging of congenital cystic lung lesions. Paediatr Respir Rev 2002; 3:120–127.
Shanmugam G, MacArthur K, Pollock JC. Congenital lung malformations − antenatal and postnatal evaluation and management. Eur J Cardiothorac Surg 2005; 27:45–52.
Maier HC. Bronchogenic cysts of the mediastinum. Ann Surg 1948; 127:476–502.
Estrera AS, Landay MJ, Pass LJ. Mediastinal carinal bronchogenic cyst: is its mere presence an indication for surgical excision? South Med J 1987; 80:1523–1526.
Lazar RH, Younis RT, Bassila MN. Bronchogenic cysts: a cause of stridor in the neonate. Am J Otolaryngol 1991; 12:117–121.
Levin DL. Morphologic analysis of the pulmonary vascular bed in congenital left-sided diaphragmatic hernia. J Pediatr 1978; 92:805–809.
Osebold WR, Soper RT. Congenital posterolateral diaphragmatic hernia past infancy. Am J Surg 1976; 131:748–754.
Ohura H, Kondo T, Iwabuchi S, Matsumura Y, Saito R, Okada Y, et al. Two cases of the congenital posterolateral diaphragmatic hernia were reported. Kyobu Geka 1996; 49:420–423.
Graivier L, Dorman GW, Votteler TP. Congenital diaphragmatic hernia in children. Surg Gynecol Obstet 1971; 132:408–410.
Campbell WA, Sanders M, Rosenkrantz T, Leo MV, Odibo A, Ling PY, et al. A center’s nine years outcome experience with congenital diaphragmatic hernia. Am J Obstet Gynecol 1998; 178:163S
Golladay ES, Katz JR, Katz H, Haller JA Jr. Delayed presentation of congenital posterolateral diaphragmatic hernia: a dramatic cause of failure to thrive. J Pediatr Surg 1981; 16:503–505.
Patradoon-Ho P, Fitzgerald DA. Lung abscess in children. Paediatr Respir Rev 2007; 8:77–84.
Zuhdi MK, Spear RM, Worthen HM, Peterson BM. Percutaneous catheter drainage of tension pneumatocele, secondarily infected pneumatocele, and lung abscess in children. Crit Care Med 1996; 24:330–333.
Trotman-Dickenson B. Radiology in the intensive care unit (part 2). J Intensive Care Med 2003; 18:239–252.
Matossian RM, Rickard MD, Smyth JD. Hydatidosis: a global problem of increasing importance. Bull World Health Organ 1977; 55:499–507.
Andersen FL. Introduction to cystic echinococcosis and description of cooperative research project in Morocco. In: Andersen FL, Ouhelli H, Kachani M, eds Compendium on cystic echinococcosis in Africa and Middle Eastern countries with special reference to Morocco. Provo, Utah: Brigham Young University; 1997. 1–17
Craig PS, Rogan MT, Allan JC. Detection, screening and community epidemiology of taeniid cestode zoonoses: cystic echinococcosis, alveolar echinococcosis and neurocysticercosis. Adv Parasitol 1996; 38:169–250.
Arinc S, Kosif A, Ertugrul M, Arpag H, Alpay L, Unal O, et al. Evaluation of pulmonary hydatid cyst cases. Int J Surg 2009; 7:192–195.
Arroud M, Afifi MA, El Ghazi K, Nejjari C, Bouabdallah Y. Lung hydatic cysts in children: comparison study between giant and non-giant cysts. Pediatr Surg Int 2009; 25:37–40.
Dopchiz MC, Elissondo MC, Andresiuk MV, Maiorini E, Gutiérrez AM, Muzulin PM, et al. Pediatric hydatidosis in the south-east of the Buenos Aires province, Argentina. Rev Argent Microbiol 2009; 41:105–111.
Turgut AT, Altinok T, TopcuS, Kosar U. Local complications of hydatid disease involving thoracic cavity: imaging findings. Eur J Radiol 2009; 70:49–56.
Zeyrek D1, Savas R, Gulen F, Demir E, Tanac R. ‘Air-bubble’ signs in the CT diagnosis of perforated pulmonary hydatid cyst: three case reports. Minerva Pediatr 2008; 60:361–364.
Brunetti E, Kern P, Vuitton DA, Writing Panel for the WHO-IWGE. Expert consensus for the diagnosis and treatment of cystic and alveolar echinococcosis in humans. Acta Trop 2010; 114:1–16.
Junghanss T, da Silva AM, Horton J, Chiodini PL, Brunetti E. Clinical management of cystic echinococcosis: state of the art, problems, and perspectives. Am J Trop Med Hyg 2008; 79:301–311.
Vasquez JC, Montesinos E, Peralta J, Rojas L, DeLaRosa J, Leon JJ. Need for lung resection in patients with intact or ruptured hydatid cysts. Thorac Cardiovasc Surg 2009; 57:295–302.
Dakak M, Caylak H, Kavakli K, Gozubuyuk A, Yucel O, Gurkok S, et al. Parenchyma-saving surgical treatment of giant pulmonary hydatid cysts. Thorac Cardiovasc Surg 2009; 57:165–168.
Dziri C, Haouet K, Fingerhut A, Zaouche A. Management of cystic echinococcosis complications and dissemination: where is the evidence? World J Surg 2009; 33:1266–1273.
Balanton R. Echinococcosis (Echinococcus granulosus and Echinococcus multilocularis). In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson textbook of pediatrics. 18th ed. Philadelphia, PA: Saunders Elsevier; 2007; chap 299: 516–1519.
This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
About this article
Cite this article
Kandil, S., Hassan, R.H., Fouda, A. et al. Unusual presentations of lung lesions in children: difficult to diagnose case series. Egypt J Bronchol 10, 212–222 (2016). https://doi.org/10.4103/1687-8426.193644
- bronchogenic cyst
- congenital diaphragmatic hernia and cystic hydatidosis
- congenital lung lesion
- lung agenesis
- pulmonary sequestration