1. Imaging Department
Oct 23rd
, 20 1 2
Reported by Dr. Giang

2.  Name: Pham Hong Ngoc
 Sex: Female
 Age: 8 months old.
 Dept: A16

3. Clinical
 High fever: 40*C ( during 3 week, 3 times/ day)
 Cough & wheeze
 No dyspnea
 No seizure
Quang Ninh Hospital ‘s diagnosis: Left Lung
Pneumonia  Has been treated for 3 days but
nothing improved
 NHP

4. Chest x-ray
 Opacification of left hemithorax ( upper lobe)
 Rightward shift of the trachea & mediastinum
 Left pleural effusion

5. Pleural pulmonary US
 Left Pleural fluid : 10 mm.
 Solid heterogeneous mass in Left upper lobe

6. CT findings
(Pre C+)
 Large soft tissue mass filling the Left upper lobe. (8x7cm)
 Pleural-based
 Heterogenous density . No calcification or Fat.
 Pushing heart, trachea & mediastinum to the right ; chest
wall to the anterior

7. CT findings
(Pre C+)
 Left pleural effusion ( 10mm)
 Pericardium effusion ( 8mm)
 Consolidation at both lung hilum

8. CT findings
(Post C+)
 Mild heterogenous enhancement
 Some low density areas with wall enhance ( cysts)

9. CT findings
(Post C+)
 Vessel traverse the mass

10. CT findings
(Post C+)
 Left superior lobar bronchus: compressed
& narrow  upper lobe : atelectasis

11. CT findings
(Lung parenchyma Post C+)
 Consolidation in both hilum

12. CT findings
(Bone window Post C+)
 No chest bone invasion

13. Lab test
 WBC: 23,9 x 10^9. CRP: 48 mg/L
 RBC: 3,87 x10^12
 HGB: 89 g/L
 HCT: 0,281 L/L

14. Diagnosis
Pleuro-pulmonary Blastoma
surinfection (type II)

15. Top Diffential Diagnosis
1. Rhabdomyosarcoma: Solid mass, invade chest wall.
2. Ewing sarcoma: Invade Rib , extra pleural, not
associated with pleural effusion
3. PNET: invade chest wall with similar appearance
4. Pulmonary inflammatory pseudotumor: often
contains calcification , smaller then PPB
5. CCAM

16. Background of PPB
1. Definition:
Rare aggressive malignant primary neoplasm of the pleuropulmonary
mesenchyme occurring in earlychildhood associated with poor
prognosis
2. Location: intra thoracic (100%) ; Pleural-based of intra-parechymal.
3. Size: Large
4. Age: < 5 years old
5. Epidemiology: Very uncommon tumor

17. Background of PPB
6. Pathology: Primitive lung tumor similar to Wilms tumor,
Neuroblastoma & Hepatoblastoma
7. Classification: Type I: Purely cystic ( Good prognosis)
Type II: Cystic and Solid
Type III: Solid ( Worse prognosis)
8. Treatment: : Surgical resection + Chemotherapy

18. Thank you for attention!