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Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report
INTRODUCTION: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises. CASE REPORT: We present a unique case of a four-year...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434292/ https://www.ncbi.nlm.nih.gov/pubmed/32926696 http://dx.doi.org/10.5811/cpcem.2020.5.47016 |
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author | Wade, Christian I. Couperus-Mashewske, Cody J. Geurts, Mia E. Derfler, Nicholas Ngo, John Couperus, Kyle S. |
author_facet | Wade, Christian I. Couperus-Mashewske, Cody J. Geurts, Mia E. Derfler, Nicholas Ngo, John Couperus, Kyle S. |
author_sort | Wade, Christian I. |
collection | PubMed |
description | INTRODUCTION: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises. CASE REPORT: We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400–12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia. CONCLUSION: This case highlights how pulmonary capillary hypoperfusion secondary to leukostasis, coupled with a ventilation/perfusion mismatch due to compression atelectasis by an enlarged thymus, resulted in this patient’s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial. |
format | Online Article Text |
id | pubmed-7434292 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine |
record_format | MEDLINE/PubMed |
spelling | pubmed-74342922020-08-20 Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report Wade, Christian I. Couperus-Mashewske, Cody J. Geurts, Mia E. Derfler, Nicholas Ngo, John Couperus, Kyle S. Clin Pract Cases Emerg Med Case Report INTRODUCTION: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises. CASE REPORT: We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400–12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia. CONCLUSION: This case highlights how pulmonary capillary hypoperfusion secondary to leukostasis, coupled with a ventilation/perfusion mismatch due to compression atelectasis by an enlarged thymus, resulted in this patient’s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial. University of California Irvine, Department of Emergency Medicine publishing Western Journal of Emergency Medicine 2020-06-19 /pmc/articles/PMC7434292/ /pubmed/32926696 http://dx.doi.org/10.5811/cpcem.2020.5.47016 Text en Copyright: © 2020 Wade et al. http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY 4.0) License. See: http://creativecommons.org/licenses/by/4.0/ |
spellingShingle | Case Report Wade, Christian I. Couperus-Mashewske, Cody J. Geurts, Mia E. Derfler, Nicholas Ngo, John Couperus, Kyle S. Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title | Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title_full | Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title_fullStr | Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title_full_unstemmed | Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title_short | Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report |
title_sort | respiratory failure due to a large mediastinal mass in a 4-year-old female with blast cell crisis: a case report |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7434292/ https://www.ncbi.nlm.nih.gov/pubmed/32926696 http://dx.doi.org/10.5811/cpcem.2020.5.47016 |
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