Surveillance of Actionable Pulmonary Nodules in Children: Th
Case Report
A 9-year-old girl with Crohn’s disease hospitalized for Clostridium difficile colitis was incidentally found to have multiple bilateral pulmonary nodules discovered on a contrast-enhanced CT of the abdomen. At that time, she had no respiratory symptoms and her pulmonary examination was unremarkable. However, pulmonary function tests (PFTs) revealed a restrictive pattern and low carbon monoxide diffusing capacity (DLCO), which were decreased from normal PFT results obtained nine months earlier in the setting of a viral illness (see Table 1 for all PFT values). A dedicated chest CT with intravenous contrast revealed bilateral upper and lower lobe pulmonary nodules in a primarily subpleural distribution, measuring up to 13 mm in greatest dimension. Margins were ill-defined and some exhibited central hypoattenuation, a feature consistent with central necrosis. Infectious etiologies seemed unlikely given the lack of overt respiratory symptoms. There was no evidence of a primary neoplasm making metastatic disease unlikely. Rheumatologic conditions such as granulomatosis with polyangiitis were ruled out by a negative cANCA, absence of renal disease and a declining ESR. Therefore, further workup of the pulmonary nodules was deferred until her GI symptoms resolved..