폐렴 평가 중 거대종괴 음영이 관찰된 영아 1예

초록

In young children presenting with respiratory symptoms and fever, chest radiography is a key tool not only for identifying infections, but also for detecting unexpected underlying pathologies. While round pneumonia is a common radiographic finding in young children, huge mass-like lesions should prompt careful differentiation between congenital and neoplastic conditions. In such cases, imaging alone may be insufficient, and excisional biopsy becomes essential for definitive diagnosis and management. A previously healthy 3-year-old boy presented with fever and upper respiratory symptoms. Chest radiography performed during a pneumonia evaluation at a local pediatric clinic revealed right upper lung consolidation. The patient tested positive for Mycoplasma pneumoniae infection and received outpatient treatment. Despite symptomatic improvement, a persistent mass-like lesion was noted on follow-up imaging. The patient was referred to a tertiary hospital for further evaluation. Contrast-enhanced chest computed tomography revealed a well-defined, 4.3×7.1×6.6-cm fatty mass in the right hemithorax, suggestive of a pleural-based lesion. Video-assisted thoracoscopic surgery was performed, and a well-encapsulated extrapleural mass was completely excised. Histopathological examination confirmed a diagnosis of lipoblastoma, a rare benign tumor arising from embryonal fat. This case highlights the diagnostic challenges in distinguishing round pneumonia from thoracic tumors in young children. Radiologic findings mimicking infection may mask underlying benign masses. Excisional biopsy plays a pivotal role in establishing a definitive diagnosis and guiding appropriate treatment. Early surgical intervention leads to favorable outcomes, although long-term follow-up is necessary due to the risk of recurrence.

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