Mediastinal mass in a healthy adolescent at The Children's Hospital at Westmead, Australia.

To cite: Khatami A, Outhred AC, Britton PN, et al. Thorax Published Online First: [please include Day Month Year] doi:10.1136/thoraxjnl-2014205764 Ameneh Khatami and Emilie Huguon A previously well adolescent from the tropical South Pacific island of Futuna was transferred due to a 3-month to 4-month history of intermittent fevers, anorexia, weight loss, lethargy and haemoptysis. A Mantoux test was negative. CT scan demonstrated a large mediastinal mass and lymphadenopathy with broncho-vascular compression, and bilateral pleural and pericardial effusions, (figure 1A). At admission, he was persistently febrile with non-tender cervical lymphadenopathy and hepatomegaly, and had moderate respiratory distress. The presumptive diagnosis was lymphoma. Initial blood tests demonstrated haemoglobin 92 g/L; white cell count 16×10/L (neutrophils 11×10/L, lymphocytes 1.3×10/L, eosinophils 1.2×10/L); erythrocyte sedimentation rate 128 mm/h; C-reactive protein 313 mg/L; normal liver and renal function tests. After 1 week, he developed acute renal impairment with peak serum creatinine 368 mmol/L. Renal ultrasound scan (USS) demonstrated bilateral increased echogenicity. Cultures and cytology of the pleural effusion were non-diagnostic. Cervical lymph node biopsies demonstrated reactive histopathological changes and fibrosis, without evidence of malignancy.