Hamartochondrome pulmonaire : une cause rare de nodule pulmonaire solitaire en pédiatrie

An isolated pulmonary nodule secondary to Streptococcus intermedius infection in an otherwise healthy 10-year-old boy: A case report and literature review

Streptococcus intermedius, as a Gram-positive commensal bacterium, tends to cause various infections, such as brain and liver abscesses, endocarditis, and empyema, especially in immunocompromised patients. However, an isolated pulmonary nodule caused by S. intermedius in previously healthy individuals without traditional risk factors is rarely reported. Herein, we present a case of a 10-year-old immunocompetent boy referred to our department with a 5-day history of intermittent, left-sided chest pain. Chest X-ray and computed tomography revealed a left lung nodule. Although his blood, sputum, and bronchoalveolar lavage fluid cultures were negative, metagenomic next-generation sequencing (mNGS) showed only the presence of S. intermedius in ultrasonography-guided lung biopsy tissue and pleural fluid (416 and 110 reads, respectively). He was then successfully treated with appropriate intravenous antibiotics and avoided surgical intervention. To the best of our knowledge, this is the first report of S. intermedius-related pulmonary nodule confirmed by mNGS analysis in healthy children. For achieving proper diagnosis and treatment, infection with S. intermedius should be included in the differential diagnosis when coming across such a similar pulmonary nodule. mNGS, as a valuable supplement to conventional culture methods, is an essential diagnostic tool for identifying pathogens without typical characteristics.

Pulmonary giant chondromatous hamartoma with multifocal evolution in an infant

Hamartoma is the most common benign pulmonary tumor in adults, but is rarely described in the pediatric population. Giant chondromatous and progressive forms are even rarer. We report the novel case of a 13-month-old infant hospitalized for giant pulmonary chondromatous hamartoma discovered during a septic episode, rapidly progressive, with severe multifocal lesions, without clear response to several cytotoxic therapies. No predisposition syndrome was identified.

[Spontaneous pneumothorax: unusual manifestation of pulmonary hamartochondroma]

L'hamartochondrome est une tumeur bénigne de l'arbre trachéo-bronchique de découverte fortuite le plus souvent et rarement symptomatique. Elle est plus fréquente chez l'homme que chez la femme. L'aspect radiologique est souvent évocateur. Le recours à la chirurgie est indiquée quand la tumeur est de grande taille et/ou symptomatique. Le diagnostic histologique ne pose en règle pas de difficulté. Nous rapportons l'observation d'une jeune patiente de 30 ans, sans antécédents pathologiques particuliers. Qui avait présenté un pneumothorax spontané, révélant un hamartochondrome pulmonaire de grande de taille. Association assez rare, mais pourrait être expliqué par le fait que ces tumeurs de composition assez anarchique, contiennent parfois des formations kystiques qui peuvent se rompre dans la plèvre et être à l'origine d'épanchements.

The incidental pulmonary nodule in a child. Part 2: Commentary and suggestions for clinical management, risk communication and prevention

The incidental detection of small lung nodules in children is a vexing consequence of an increased reliance on CT. We present an algorithm for the management of lung nodules detected on CT in children, based on the presence or absence of symptoms, the presence or absence of elements in the clinical history that might explain these nodules, and the imaging characteristics of the nodules (such as attenuation measurements within the nodule). We provide suggestions on how to perform a thoughtfully directed and focused search for clinically occult extrathoracic disease processes (including malignant disease) that may present as an incidentally detected lung nodule on CT. This algorithm emphasizes that because of the lack of definitive information on the natural history of small solid nodules that are truly detected incidentally, their clinical management is highly dependent on the caregivers' individual risk tolerance. In addition, we present strategies to reduce the prevalence of these incidental findings, by preventing unnecessary chest CT scans or inadvertent inclusion of portions of the lungs in scans of adjacent body parts. Application of these guidelines provides pediatric radiologists with an important opportunity to practice patient-centered and evidence-based medicine.

Giant cystic chondroid hamartoma of the lung

Pulmonary hamartoma composed of an abnormal mixture of mesenchymal elements is the most common benign neoplasm in the lung. Pulmonary hamartoma larger than 10 cm and the cystic variant are also very rare. We describe an asymptomatic 11-year-old boy with a huge mass in the right hemithorax. Chest computed tomography revealed a heterogeneous mass filling the middle and the lower lobes of the right lung. The patient underwent thoracotomy and resection of the lesion. Gross examination of the surgical specimen showed a well-circumscribed, encapsulated, lobulated, and bluish-white mass, measuring 18 x 16 x 8 cm. Multilocular cystic spaces with intervening lobulated fragments of cartilaginous tissue and adipose tissue were seen. Microscopically, the solid component was composed of cartilage and adipose tissue. Cystic areas and cleft-like spaces were lined by ciliated columnar epithelium. We believe this is the first case of 'giant cystic chondroid hamartoma of the lung' described in childhood. We suggest that giant cystic pulmonary hamartoma should be included in the differential diagnosis of large intrathoracic masses in children.

MR imaging findings of an atypical pulmonary hamartoma in a 12-year-old child

We present the MR imaging findings in an atypical pulmonary hamartoma in a 12-year-old boy. CT showed no evidence of fat or calcifications in the tumour. It demonstrated peripheral rim enhancement on arterial-phase MR images due to a compressed respiratory epithelium, and progression to nearly homogeneous contrast enhancement on delayed-phase images. Small cystic spaces were identified on MR hydrographic and contrast-enhanced images formed by invaginating respiratory epithelium, a unique imaging finding in this condition.