Case 81

 A two years and six months-old infant presented for right cervical mass with his mother. He had experienced dyspnea like croup syndrome repeatedly for this previous one month. Ten days ago, he went to an emergency hospital for dyspnea and cyanosis. He was given steroid hormone based on the diagnosis of croup syndrome. His edematous face and swollen cervical lymphnodes were also repeatedly found. However, no fever was found. Blood test in a local clinic revealed no abnormal findings. Although his respiratory symptoms were recovered, the size of right cervical lymphnode was remarkably increased. His mother agreed him to receive non-enhanced CT (Fig. 1) for further investigation. Eventually, he was introduced to pediatrics-expert hospital to check whether the cervical lymphnode was malignant or not. He underwent enhanced CT using contrast medium (Fig. 2, 3) at the hospital.

What is your diagnosis based on clinical symptoms and images of CT ?

1. Metastatic swollen lymphnodes

2. Lipoblastoma

3. Malignant lymphoma

4. Lemierre syndrome

5. Langerhans cell histiocytosis

answer

2017.11.22