Miyagi Hisayuki, Ishii Daisuke, Hirasawa Masatoshi, Yasuda Shunsuke, Toriumi Naohisa, Sarashina Takeo, Tanino Mishie, Tanaka Mio, Tanaka Yukichi, Miyamoto Kazutoshi
Division of Pediatric Surgery, Department of Surgery, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
Respiratory Center, Asahikawa Medical University, 2-1-1-1 Midorigaoka Higashi, Asahikawa, 078-8510, Japan.
Surg Case Rep. 2020 May 24;6(1):109. doi: 10.1186/s40792-020-00873-2.
Spontaneous pneumothorax occurs more often in younger, slim, and shallow-chested men. Although less common, differential diagnoses for secondary pneumothorax in children are asthma, emphysematous blebs, catamenial pneumothorax, and others. We report a patient who presented with pneumothorax and was found to have an inflammatory myofibroblastic tumor (IMT)-like lesion, and present a review of the related literature.
A 14-year-old girl visited her physician for chest pain that developed while exercising. Although chest drainage was performed, the symptoms associated with a collapsed lung did not improve, and she was referred to our hospital. Computed tomography revealed the presence of a 19 × 17-mm cyst with a thick wall in the apex of the right lung. She was tested for infectious diseases, namely tuberculosis, but the results were not definitive. Catamenial pneumothorax was also suspected because she was menstruating when she presented to our hospital. As a therapeutic diagnosis, we performed a thoracoscopic partial resection of the right upper lobe of the lung. Three small openings were identified inside the cyst, suggesting connection with the bronchiole. The lesion was pathologically diagnosed as an IMT-like lesion. Considering the progress so far, we considered that the final diagnosis to be an IMT. The patient was discharged on postoperative day 3, and we have followed her for the past 6 months with no local recurrence or metastasis.
IMT is not uncommon in children. Therefore, this lesion should be considered as a possible diagnosis if children and young adults develop spontaneous pneumothorax.
自发性气胸在年轻、体型瘦且胸廓浅的男性中更为常见。儿童继发性气胸的鉴别诊断虽不常见，但包括哮喘、肺大疱、月经性气胸等。我们报告一名出现气胸并被发现患有炎性肌纤维母细胞瘤（IMT）样病变的患者，并对相关文献进行综述。
一名14岁女孩因运动时出现胸痛就诊。尽管进行了胸腔引流，但肺萎陷相关症状并未改善，随后她被转诊至我院。计算机断层扫描显示右肺尖有一个19×17毫米的厚壁囊肿。对她进行了传染病检测，即结核病检测，但结果不明确。由于她来我院就诊时正在 menstruating，也怀疑是月经性气胸。作为治疗性诊断，我们对右肺上叶进行了胸腔镜部分切除术。在囊肿内发现三个小开口，提示与细支气管相连。该病变经病理诊断为IMT样病变。考虑到目前的进展，我们认为最终诊断为IMT。患者术后第3天出院，在过去6个月里我们对她进行了随访，未发现局部复发或转移。
IMT在儿童中并不罕见。因此，如果儿童和年轻人出现自发性气胸，应考虑将这种病变作为一种可能的诊断。
