ALL with mediastinal adenopathy
Presented with headache and vomiting. Normal MRI brain. Representation. Routine blood results yielded a white cell count above 30.
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The chest x-ray is abnormal. There is mediastinal lymphadenopathy. The lungs are clear and the heart is normal. No effusion.
In the context of a markedly elevated WBC count, the chest x-ray appearances are consistent with adenopathy secondary to a haematogenous malignancy.
The blood film confirmed ALL. No further imaging was obtained.
Follow up chest radiograph was normal after treatment.
The differential diagnosis for mediastinal lymphadenopathy in a child include leukemia (in this case ALL), but Hodgkin lymphoma is probably top of the differential. TB and sarcoidosis should also be included.