This 13 year old boy was admitted to the hospital for evaluation of a rapidly growing anterior chest wall mass. He was well until 4 days before admission when he developed a dry cough and a left chest wall rash. This was followed by shortness of breath and chest pain when attempting to raise his left arm. His past medical history was significant for a chromosomal abnormality associated with dysmorphic facies, hypospadius,submucosal cleft palate, and mild hearing loss. A chest CAT scan showed a triangular soft tissue density lateral to his left ventricle, eroding through the chest wall, with volume loss and consolidation of the underlying lung, and a moderate sized left pleural effusion. An echocardiogram, electrocardiogram, bone marrow biopsy and lumbar puncture were normal. In the operating room a biopsy of the left chest wall mass showed abscess formation, granulation tissue, histiocytic reaction and colonies of a filamentous organism most consistent with actinomycosis. The mass was felt to infiltrate through multiple tissue planes and was probably the result of aspiration pneumonia. He was initially started on clindamycin and azithromycin; after the biopsy the antibiotics were switched to penecillin G. The chest wall mass and symptoms resolved within several days, and he was discharged home on oral amoxacillin for 4-6months. Cultures from the chest mass are pending.
Description
anterior chest wall mass with hyperpigmentation; wound from thoracotomy for biopsy of mass
