Introduction Pleuropulmonary blastoma (PPB) is an uncommon but aggressive embryonal or blastemic neoplasm found in children and which has an unfavourable outcome [1]. The tumour may be regarded as the pulmonary dyson- togenetic analogue to Wilms’ tumour in the kidney, neuroblastoma in the adrenal gland, and hepatoblas- toma in the liver [2]. It is characterised by primitive mesenchymal elements, including undifferentiated blas- tema and often cartilaginous, rhabdomyoblastic or fibroblastic differentiation, with epithelial-lined spaces. Polysomy of chromosome 8 is a consistent feature of the malignant mesenchymal elements of the tumour, but the epithelial cells show no chromosome 8 gains. This is in contrast to adult pulmonary blastoma where the epi- thelial component is malignant [3]. Spontaneous dislodgement of a thrombus resulting in a large cerebral infarct following uneventful surgery is rare. When there is no coagulopathy, most reported cases of tumour emboli have been secondary to intra- cardiac tumours or rapidly growing lung tumours [4]. We present PPB in a 3-year-old girl who developed a large infarct of the left middle cerebral territory 24 h after thoracic surgery. Case report A 3-year-old girl presented with symptoms of respiratory infection and myalgia. An AP chest radiograph (Fig. 1) showed complete opacification of the left hemithorax with mass effect mimicking pneumonia and empyema. Contrast-enhanced CT (Fig. 2) revealed a large, heterogeneous, left thoracic mass encasing the left pul- monary hilum and left atrium. It had fairly low attenuation with whorls of soft tissue. The mass had ruptured and there was a large pleural effusion. She underwent thoracotomy the next morning where a 360-g tumour was found in the left hemithorax adherent to the lung, pericardium, great vessels and diaphragm, and encasing the left Anne P.A. Tan Kendrick Ganesh Krishnamurthy V.T. Joseph Pleuropulmonary blastoma with a large embolic cerebral infarct Received: 25 February 2003 Accepted: 19 March 2003 Published online: 24 April 2003 Ó Springer-Verlag 2003 Abstract We report on a 3-year-old girl who developed a large embolic cerebral infarct 1 day after an uneventful thoracotomy to remove a large pleuropulmonary blastoma. The tumour had encased the heart and great vessels and ruptured into the left hemithorax. Pleuropulmo- nary blastoma is a rare, but unique, primary thoracic neoplasm in young children and, to our knowledge, the development of a secondary large embolic cerebral infarct is also uncommon and has not been re- ported in this tumour. Keywords Head Æ Brain Æ Thorax Æ Lungs Æ Neoplasm primary Æ Metastases Æ Ischaemia/ infarction Æ Pleuropulmonary blastema Pediatr Radiol (2003) 33: 506–508 DOI 10.1007/s00247-003-0926-5 CASE REPORT A.P.A. Tan Kendrick (&) G. Krishnamurthy Department of Diagnostic Imaging, Kandang Kerbau Women’s and Children’s Hospital, 100 Bukit Timah Road, Singapore 229899 E-mail: annetan@kkh.com.sg Tel.: +65-63-942284 Fax: +65-63-942258 V.T. Joseph Department of Paediatric Surgery, Kandang Kerbau Women’s and Children’s Hospital, Singapore