Vertelney Haley, Lin-Martore Margaret
University of California, San Francisco, Department of Emergency Medicine, San Francisco, California.
Clin Pract Cases Emerg Med. 2021 Aug;5(3):316-319. doi: 10.5811/cpcem.2021.3.51958.
Chest wall masses are rare in children, but the differential diagnosis is broad and can include traumatic injury, neoplasm, and inflammatory or infectious causes. We report a novel case of an eight-year-old, previously healthy female who presented to the emergency department (ED) with one month of cough, fevers, weight loss, and an anterior chest wall mass.
The patient's ultimate diagnosis was necrotizing pneumonia with pneumatocele extending into the chest wall. This case is notable for the severity of the patient's pulmonary disease given its extension through the chest wall, and for the unique speciation of her infection.
Although necrotizing pneumonia is a rare complication of community-acquired pneumonia, it is important for the emergency physician to recognize it promptly as it indicates severe progression of pulmonary disease even in children with normal and stable vital signs, as in this case. The emergency physician should consider complications of pneumonia including pneumatocele and empyema necessitans when presented with an anterior chest wall mass in a pediatric patient. Additionally, point-of-care ultrasound was used in the ED to facilitate the diagnosis of this illness and was particularly useful in determining the continuity of the patient's lung infection with her extrathoracic chest wall mass.
胸壁肿块在儿童中较为罕见，但其鉴别诊断范围广泛，可包括创伤性损伤、肿瘤以及炎症或感染性病因。我们报告了一例新颖的病例，一名8岁、此前健康的女性因咳嗽、发热、体重减轻1个月以及前胸壁肿块就诊于急诊科。
该患者最终诊断为坏死性肺炎伴肺大疱延伸至胸壁。此病例值得注意的是，鉴于其肺部疾病通过胸壁的延伸程度，患者肺部疾病的严重程度以及其感染的独特菌种。
尽管坏死性肺炎是社区获得性肺炎的一种罕见并发症，但对于急诊医生而言，及时识别它很重要，因为这表明即使在生命体征正常且稳定的儿童中，如本病例，肺部疾病也已严重进展。当儿科患者出现前胸壁肿块时，急诊医生应考虑肺炎的并发症，包括肺大疱和脓胸。此外，急诊科使用了床旁超声来辅助诊断该疾病，并且在确定患者肺部感染与胸壁外肿块的连续性方面特别有用。
