Shortness of breath in an infant with history of acute lymphoblastic leukemia

Gupta, Rajesh; Butler, Rhett H.

doi:10.1016/j.jemermed.2004.08.014

Cited by 1 publication

(2 citation statements)

References 6 publications

(6 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A thymic mass is identified in 50% of patients with T-cell acute lymphoblastic leukemia, and can lead to airway obstruction. [4][5][6] In our patient's case, and as evidenced by an extremely elevated alveolar-arterial gradient of 577 mm Hg, her mediastinal mass likely caused compression atelectasis leading to a ventilation/perfusion mismatch, which manifested as hypoxia and respiratory distress. The mass also likely contributed to the extreme difficulty in ventilating the patient and the need for high pressures.…”

Section: Discussionmentioning

confidence: 73%

See 1 more Smart Citation

Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report

Wade

Couperus-Mashewske

Geurts

et al. 2020

Clinical Practice and Cases in Emergency Medicine

View full text Add to dashboard Cite

Introduction: Symptomatic leukostasis is an exceptionally atypical presentation of blast crisis; and when coupled with an enlarged neoplastic mediastinal mass in a four-year-old female, an extremely rare and challenging pediatric emergency arises. Case Report: We present a unique case of a four-year-old female who arrived via emergency medical services in cardiopulmonary arrest with clinical and radiographic evidence suggestive of bilateral pneumothoraces, prompting bilateral chest tube placement. Further evaluation revealed a large mediastinal mass and a concurrent white blood cell count of 428,400 per milliliter (/mL) (4,400-12,900/mL), with a 96% blast differential, consistent with complications of T-cell acute lymphoblastic leukemia. Conclusion: This case highlights how pulmonary capillary hypoperfusion secondary to leukostasis, coupled with a ventilation/perfusion mismatch due to compression atelectasis by an enlarged thymus, resulted in this patient’s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial.

show abstract

Section: Discussionmentioning

confidence: 73%

“…3 Additionally, approximately 50% of patients with T-cell acute lymphoblastic leukemia were also identified to have a thymic mass. [4][5][6] An extremely rare and challenging emergency therefore arises when pulmonary capillary hypoperfusion is coupled with compressive atelectasis by a large neoplastic mediastinal mass.…”

Section: Introductionmentioning

confidence: 99%