CLINICAL HISTORY.—A 10-year-old white girl developed a chronic, nonproductive cough six months prior to admission. During the month prior to admission, she complained of anorexia, vomited intermittently, and was noted to have lost 4.1 kg (9 lb). Two weeks prior to admission, her parents observed that the right side of her thorax was larger than the left side, and that a mass was present beneath the right scapula. She entered the hospital with decreasing exercise tolerance and increasing shortness of breath.
Physical examination revealed a well developed, well nourished, dyspneic girl with a dry, brassy cough. Her temperature was 99.4 F (37.4 C); pulse, 100 beats per minute; respirations, 30 breaths per minute; blood pressure, 100/60 mm Hg; weight, 41.6 kg (92 lb) (75th percentile); and height, 154 cm (5 ft 1 inch) (97th percentile). Positive physical findings were limited to the chest. The hemithorax on the right was larger