{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T16:44:27Z","timestamp":1726505067624},"reference-count":13,"publisher":"California Digital Library (CDL)","issue":"3","license":[{"start":{"date-parts":[[2020,6,19]],"date-time":"2020-06-19T00:00:00Z","timestamp":1592524800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>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. \n\nCase 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.\n\nConclusion: 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\u2019s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial.<\/jats:p>","DOI":"10.5811\/cpcem.2020.5.47016","type":"journal-article","created":{"date-parts":[[2020,8,12]],"date-time":"2020-08-12T15:31:43Z","timestamp":1597246303000},"page":"400-403","source":"Crossref","is-referenced-by-count":0,"title":["Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report"],"prefix":"10.5811","volume":"4","author":[{"given":"Christian","family":"Wade","sequence":"first","affiliation":[{"name":"Uniformed Services University of the\u00a0Health Sciences, School of Medicine, Department of Emergency Medicine, Bethesda, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cody","family":"Couperus-Mashewske","sequence":"additional","affiliation":[{"name":"University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mia","family":"Geurts","sequence":"additional","affiliation":[{"name":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicholas","family":"Derfler","sequence":"additional","affiliation":[{"name":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Ngo","sequence":"additional","affiliation":[{"name":"Providence St. Peter Hospital Olympia, Department of Emergency Medicine, Olympia, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyle","family":"Couperus","sequence":"additional","affiliation":[{"name":"Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"29705","published-online":{"date-parts":[[2020,6,19]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Morris CM. Blast crisis.\u00a0Encyclopedia of Cancer. 2017;432-3.","DOI":"10.1007\/978-3-642-16483-5_663"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Giammarco S. Hyperleukocytosis\u00a0and leukostasis:\u00a0management\u00a0of a medical\u00a0emergency. Exp Rev Hematol. 2017;10(2):147-54.","DOI":"10.1080\/17474086.2017.1270754"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Ali AM, Mirrakhimov AE, Abboud CN, et al. Leukostasis in adult acute hyperleukocytic leukemia: a clinician\u2019s digest.\u00a0Hematol Oncol. 2016;34:69-78.","DOI":"10.1002\/hon.2292"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Manchanda S, Bhalla AS, Jana M, et al. Imaging of the pediatric thymus: clinicoradiologic approach. World J Clin Pediatr. 2017;6(1):10-23.","DOI":"10.5409\/wjcp.v6.i1.10"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Gupta R and Butler RH. Shortness of breath in an infant with history of acute lymphoblastic leukemia.\u00a0J Emerg Med. 2005;28(1):79-81.","DOI":"10.1016\/j.jemermed.2004.08.014"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Heinz P and Dunne J. Wheeze and mediastinal mass: a challenging patient.\u00a0Emerg Med Australas. 2004;16(3):241-3.","DOI":"10.1111\/j.1742-6723.2004.00573.x"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Francis IR, Glazer GM, Bookstein FL, et al. The thymus: reexamination of age-related changes in size and shape.\u00a0Am J Roentgenol.\u00a01985;145(2):249-54.","DOI":"10.2214\/ajr.145.2.249"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Nasseri F and Eftekhari F. Clinical and radiologic review of the normal and abnormal thymus: pearls and pitfalls.\u00a0Radiographics. 2010;30(2):413-28.","DOI":"10.1148\/rg.302095131"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Gravel CA and Bachur RG. Point-of-care ultrasound differentiation of lung consolidation and normal thymus in pediatric patients: an educational case series. J Emerg Med. 2018;55:235-9.","DOI":"10.1016\/j.jemermed.2018.04.026"},{"key":"ref9","doi-asserted-by":"crossref","unstructured":"Newman B. Ultrasound body applications in children.\u00a0Ped Rad. 2011;41(2):555.","DOI":"10.1007\/s00247-011-2107-2"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Porcu P, Farag S, Marcucci G, et al. Leukocytoreduction for acute leukemia.\u00a0Ther Apher. 2002;6:15-23.","DOI":"10.1046\/j.1526-0968.2002.00402.x"},{"key":"ref11","unstructured":"Stapczynski JS and Tintinalli JE.\u00a0Tintinalli\u2019s Emergency Medicine: A Comprehensive Study Guide. 2016."},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Shiber JR and Fines RE. Cerebral hemorrhage due to hyperleukocytosis. J Emerg Med. 2011;40(6):674-7.","DOI":"10.1016\/j.jemermed.2008.11.018"}],"container-title":["Clinical Practice and Cases in Emergency Medicine"],"original-title":[],"deposited":{"date-parts":[[2020,9,16]],"date-time":"2020-09-16T15:12:55Z","timestamp":1600269175000},"score":1,"resource":{"primary":{"URL":"https:\/\/escholarship.org\/uc\/item\/7581435h"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,19]]},"references-count":13,"issue-title":["Clinical Practice and Cases in Emergency Medicine"],"journal-issue":{"issue":"3","published-online":{"date-parts":[[2020,8,6]]}},"URL":"https:\/\/doi.org\/10.5811\/cpcem.2020.5.47016","relation":{},"ISSN":["2474-252X","2474-252X"],"issn-type":[{"type":"electronic","value":"2474-252X"},{"type":"print","value":"2474-252X"}],"subject":[],"published":{"date-parts":[[2020,6,19]]}}}