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{
    "pk": 849,
    "title": "Respiratory Failure Due to a Large Mediastinal Mass in a 4-year-old Female with Blast Cell Crisis: A Case Report",
    "subtitle": null,
    "abstract": "Introduction:\n 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.\nCase Report:\n 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.\nConclusion:\n 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’s respiratory arrest. Furthermore, the case highlights how mediastinal masses in pediatric patients present potential diagnostic challenges for which ultrasound may prove beneficial.",
    "language": "en",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Blast Cell Crisis"
        },
        {
            "word": "Hyperleukocytosis with Leukostasis"
        },
        {
            "word": "Thymus"
        },
        {
            "word": "Mediastinal Mass"
        },
        {
            "word": "Acute Lymphoblastic Leukemia"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/7581435h",
    "frozenauthors": [
        {
            "first_name": "Christian",
            "middle_name": "I.",
            "last_name": "Wade",
            "name_suffix": "",
            "institution": "Uniformed Services University of the Health Sciences, School of Medicine, Department of Emergency Medicine, Bethesda, Maryland",
            "department": "None"
        },
        {
            "first_name": "Cody",
            "middle_name": "J.",
            "last_name": "Couperus-Mashewske",
            "name_suffix": "",
            "institution": "University of Maryland Medical Center, Department of Emergency Medicine, Baltimore, Maryland",
            "department": "None"
        },
        {
            "first_name": "Mia",
            "middle_name": "E.",
            "last_name": "Geurts",
            "name_suffix": "",
            "institution": "Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington",
            "department": "None"
        },
        {
            "first_name": "Nicholas",
            "middle_name": "",
            "last_name": "Derfler",
            "name_suffix": "",
            "institution": "Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington",
            "department": "None"
        },
        {
            "first_name": "John",
            "middle_name": "",
            "last_name": "Ngo",
            "name_suffix": "",
            "institution": "Providence St. Peter Hospital Olympia, Department of Emergency Medicine, Olympia, Washington",
            "department": "None"
        },
        {
            "first_name": "Kyle",
            "middle_name": "S.",
            "last_name": "Couperus",
            "name_suffix": "",
            "institution": "Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, Washington",
            "department": "None"
        }
    ],
    "date_submitted": "2020-06-20T05:51:11+08:00",
    "date_accepted": "2020-06-20T05:51:11+08:00",
    "date_published": "2020-06-20T05:51:52+08:00",
    "render_galley": null,
    "galleys": [
        {
            "label": "",
            "type": "",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/849/galley/601/download/"
        }
    ]
}