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50 Years Ago in The Journal of PediatricsCONFERENCE AT RAYMOND BLANK MEMORIAL HOSPITAL FOR CHILDREN, DES MOINES, IOWA

Hill LF. J Pediatr 1951;38:511-24

The Journal of Pediatrics has long valued case discussions as an important teaching tool. In 1951 they appeared underthe heading “Clinical Conferences,” which later evolved to “Clinical-Pathological Conferences,” and now can be foundin our Grand Rounds section.

The case discussed by Dr Hill and his colleagues is that of an 8-week-old infant referred for evaluation of a persistentparoxysmal cough and rapid respirations. The description of the physical examination reminds us of an art lost bymany practitioners in its mention of hyperresonance on percussion of the left chest and apical cardiac thrust to the leftof the sternal margin. Dullness extended well to the right of the sternum, and the trachea was palpated to deviate far tothe right. Roentgenograms revealed the heart and mediastinum to be displaced markedly to the right. The area of theleft lung was filled with a large, air-containing cystic lesion. The cyst was surgically removed and identified by thepathologist as a “lung cyst of bronchial type.”

The microscopic description of the cyst by the pathologist clearly places this cyst in the category of what today isknown as congenital cystic adenomatoid malformation of the lung. These malformations are now frequently diagnosed by pre-natal ultrasonography and generally have a good prognosis with surgical excision. Pathologists have subclassified thesecysts on the basis of their gross and microscopic appearance. The value of such classification is that it may provide cluesto the pathogenesis of these lesions. It remains to be determined whether these malformations are the result of inherentprogramming defects or secondary to a localized abnormality during development.

John J. Buchino, MDChief of Pathology

Kosair Children’s HospitalLouisville, KY 40232

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