Case 326

Female patient, 3 years and 6 months old, presenting dry cough, paroxysmal, associated with dyspnea on medium exertion and abdominal pain two months ago. She was medicated with salbutamol and beclomethasone, without improvement. She developed persistent fever (38.5ºC) and nasal congestion and received amoxicillin for 14 days. In a new clinical reassessment, the persistence of respiratory symptoms and worsening abdominal pain were observed. She was referred for hospitalization and, after a chest X-ray, amoxicillin associated with potassium clavulanate was started. On the 4th day of hospitalization, an alternative diagnosis was suspected, and chest computed tomography was requested.

Image 1: Chest radiograph, orthostatic position. Image 2: Computed tomography (CT), axial scan, carina level, after intravenous injection of iodinated contrast, mediastinal window. Image 3: Computed tomography (CT), axial scan, carina level, after intravenous injection of iodinated contrast, lung window. Image 4: Computed tomography (CT) of the thorax, coronal reconstruction, level of the vertebral bodies, after intravenous injection of iodinated contrast, mediastinal window.

(2008-TEP / PEDIATRIC SPECIALIST TITLE) A four-year-old female with a low-grade fever a month ago is taken to the health clinic. Physical examination: pallid + / 4 +. Laboratory tests: Ht: 29%, VHS: 85 mm / hour, VCM: 85fl. Chest radiography: massive mass in the posterior mediastinum of irregular contours, with calcifications.
Question:
This clinical presentation is suggestive of: