TY - JOUR T1 - Mediastinal mass in a healthy adolescent at The Children's Hospital at Westmead, Australia JF - Thorax JO - Thorax SP - 194 LP - 197 DO - 10.1136/thoraxjnl-2014-205764 VL - 70 IS - 2 AU - Ameneh Khatami AU - Alex C Outhred AU - Philip N Britton AU - Emilie Huguon AU - David J E Lord AU - Melanie Wong AU - Amanda Charlton AU - Alison M Kesson AU - David Isaacs Y1 - 2015/02/01 UR - http://thorax.bmj.com/content/70/2/194.abstract N2 - 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. Figure 1 Radiology investigations of patient with disseminated conidiobolomycosis. (A) CT scan on admission performed in prone due to respiratory distress demonstrating amorphous soft tissue mass filling the mediastinum and aortopulmonary window with compression of the right main bronchus (dotted arrow) and obstruction of the superior vena cava leading to accessory venous pathways filled with high-density contrast (solid arrow), bilateral pleural thickening and fluid (greater on the right) and irregular opacities in the right lung probably representing atelectasis. (B) CT scan after 3 weeks of antifungal treatment demonstrating several small, hypodense lesions throughout the liver (black arrows), multiple large wedge-shaped hypodense areas representing areas of infarction in the spleen and both kidneys and bilateral pleural effusions (greater on the left). (C) Positron emission tomography (PET) scan after 5 weeks highdose intravenous liposomal amphotericin demonstrating multiple foci of increased metabolic activity in the mediastinum, abdomen and soft tissues including in the right hand, bone involvement in the left 7th rib, a large left pleural effusion and non-uniform uptake in the cardiac muscle. (D) Follow-up PET scan after further 6 weeks intravenous liposomal amphotericin with addition of voriconazole and oral terbinafine, and 3 weeks of intravenous and oral prednisolone demonstrating significant clearance of infective foci. Initial blood tests demonstrated haemoglobin 92 g/L; white cell count 16×109/L (neutrophils 11×109/L, lymphocytes 1.3×109/L, eosinophils 1.2×109/L); erythrocyte … ER -