Case reportAt the age of 4 yrs the male child suffered from a Wilms-tumour of the right kidney treated by polychemotherapy (SIOP No. 9 for stage 1 using actinomycin and vincristin) and surgical removal. A year later, abdominal pain occurred and a local relapse of the Wilms-tumour was diagnosed. Further diagnostics revealed infiltration into the liver, diaphragm, and the thoracic wall. In addition, three lung metastases were found. The child received polychemotherapy again (according to protocol SIOP 93/01 for stage 4 using adriamycin, etoposide, carboplatin, ifosphamide) and radiotherapy of the lung, abdomen (15 Gray) and of the tumour site (35 Gray). The tumour could be resected. All follow-ups during the next 6 yrs showed remission and the child was healthy.At the age of 11 yrs, he presented with fever and cough. The chest radiograph showed an opacity of the left upper field ( fig. 1). Under the suspicion of pneumonia, antibiotic treatment was started. Due to bronchial obstruction, the child received low-dose inhaled steroids and b-adrenergic agents. Nonetheless, he still suffered from bronchial obstruction and intermittent fever. Pulmonary function measurement revealed a mixed restrictive and obstructive ventilation disorder (forced vital capacity 52%, forced expiratory volume in one second 49% and flow at 25% vital capacity 13% predicted). Computed tomography (CT) scan of the thorax (including radioopaque material) was performed ( fig. 2).For further diagnosis flexible bronchoscopy was performed, revealing a ball-shaped, soft, solid tumour deriving from the left upper lobe bronchus and bulging into the ostium of the left main bronchus ( fig. 3). In order to obtain a thorough diagnosis of the tumour, thoracic surgical intervention was performed. The histology of the tumour revealed typical findings ( fig. 4).

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CONTEXT CONTEXT One advantage of computed tomographic pulmonary angiograms (CTPA) is that they often show pathology in patients in whom pulmonary embolism (PE) has been excluded. In this investigation, we identified the ancillary findings on CTPAs that were negative for PE to obtain an impression of the type of findings shown. METHODS METHODS This was a retrospective analysis of findings on CTPAs that were negative for PE obtained in nine emergency departments between January 2016-February 2018. Ancillary findings were assessed by review of the radiographic reports. RESULTS RESULTS Ancillary findings were identified in N=338 (40.9%) of 825 patients with CTPAs that were negative for PE. Most ancillary findings, 254 (75.1%) of 338 were pulmonary or pleural abnormalities. Liver, gall bladder, kidney, or pancreatic abnormalities were shown in 26 (7.7%) cases, and abnormalities of the heart or great vessels were shown in 23 (6.8%) of cases. Abnormalities of the esophagus or intestine were shown in 12 (3.6%), abnormalities of the thyroid in 10 (3.0%) and abnormalities of bone or soft tissue lesions were shown in three (0.9%) cases. Inferential statistical procedures demonstrated that the occurrence of ancillary findings in patients with negative CTPAs was proportionately greater in patients who were 50 years and older (p < 0.001), although not between genders (p = 0.145). CONCLUSIONS CONCLUSIONS Ancillary findings on CTPAs that were negative for PE were frequently reported. Future studies might focus of the extent to which ancillary findings on CTPA assisted physicians in management of the patient.

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