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Pathological Case of the Month

Janet E. Roepke, MD, PhD; Stephen A. Heifetz, MD
Arch Pediatr Adolesc Med. 1997;151(3):317-319. doi:10.1001/archpedi.1997.02170400103020.
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A 12-YEAR-OLD white girl was seen with a 2-week history of productive cough and hemoptysis. Her family history and medical history were noncontributory.

The results of physical examination were unremarkable except for decreased breath sounds bilaterally and a palpable liver 4 cm below the right costal margin. A chest x-ray film revealed cardiomegaly and bilateral diffuse nodules, some of which appeared cavitary (Figure 1). The patient's hemoglobin level was 91 g/L and her hematocrit was 0.26, with a mean corpuscular volume of 83 fL. The findings of coagulation studies, a serum chemistry profile including liver function tests, and rheumatologic tests were all normal. The sputum tested negative for acid-fast bacilli, and blood and urine cultures were negative for organisms. No granulomas were identified with bronchoscopy.

Echocardiography disclosed a pericardial effusion. A pericardial window was performed and revealed a hemorrhagic effusion. Biopsy specimens of the lung nodules were obtained (Figures 2


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