A simplified approach for anaesthetic management of diagnostic procedures in children with anterior mediastinal mass

INTRODUCTION@#Children with an anterior mediastinal mass (AMM) need general anaesthesia (GA) or deep sedation for diagnostic procedures more often than adult patients. Anaesthetic management to prevent such complications includes maintenance of spontaneous ventilation (SV) and prebiopsy corticosteroids/radiotherapy.@*METHODS@#We reviewed the medical records of children with AMM who were brought to the operating theatre for diagnostic procedures (prior to chemotherapy) between 2001 and 2013. Our aim was to describe the clinical features, radiological findings and anaesthetic management, as well as determine any association with complications.@*RESULTS@#25 patients (age range 10 months-14 years) were identified during the study period. Corticosteroid therapy was started before the biopsy for one patient. All 25 patients had GA/sedation. A senior paediatric anaesthesiologist was involved in all procedures. Among 13 high-risk patients, SV was maintained in 11 (84.6%) patients, ketamine was used as the main anaesthetic in 8 (61.5%) patients, 6 (46.2%) patients were in a sitting position and no airway adjunct was used for 7 (53.8%) patients. There were 3 (12.0%) minor complications.@*CONCLUSION@#Based on our results, we propose a simplified workflow, wherein airway compression of any degree is considered high risk. For patients with high-risk features, multidisciplinary input should be sought to decide whether the child would be fit for a procedure under GA/sedation or considered unfit for any procedure. Recommendations include the use of less invasive methods, involving experienced anaesthesiologists to plan the anaesthetic technique and maintaining SV.

Idiopathic multilocular thymic cyst-an incidental anterior mediastinal mass

Acquired thymic cyst are multilocular and they occur de novo or in association with mediastinal neoplasm, systemic autoimmune diseases and trauma. Here, we report a case of acquired multilocular thymic cyst due to non-specific inflammatory etiology in a 42-year old gentleman and our approach to diagnosis and management of anterior mediastinal mass. With no specific clinical symptom, he was diagnosed with anterior mediastinal mass incidentally by imaging studies. Definitive diagnosis of multilocular thymic cyst was obtained by tissue diagnosis of the anterior mediastinal mass resected during the surgery.

A case report on incidental finding of thymoma as anterior mediastinal mass

Thymomas are rare tumors in the anterior mediastinum, representing 50% of anterior mediastinal masses and about 20-30% of all mediastinal tumors. They are of unknown etiology; about 50% of patients with thymomas are diagnosed incidentally with chest radiography. Thymoma is classified into different stages, which determine the prognosis and type of management, the standard primary treatment for these tumors is Thymectomy. We present a case of 55-year female presented with shortness of breath, cough with expectoration and fever for past ten days. Chest x-ray revealed mediastinal widening. CECT chest showed a well-circumscribed heterogeneous solid enhancing mass lesion. FNAC was planned that showed features in favour of thymoma. Biopsy was done that confirmed lymphocyte rich type B thymoma.

Disseminated Salmonella Infection Coexisting with Thymoma.

A 21-year-old boy presented with high grade fever, diffuse chest pain and exertional breathlessness of one month duration. Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi. The same pathogen was isolated in subsequent blood and sputum cultures. This current report describes the rare association of salmonella infection with thymoma.

A Huge Anterior Mediastinal Thymoma of an Infant: A Case Report / 임상소아혈액종양

A seven months old male infant visited Severance Children's Hospital for evaluation of anterior mediastinal mass. With chest computed tomography (CT) image and biopsy, precursor T-cell lymphoblastic lymphoma was suspected but the ultrasonography guided biopsy specimen was insufficient to confirm the disease. Because there was a life-threatening risk to perform open biopsy to the small infant, we started chemotherapy empirically. The mass decreased, however, the lesion increased again and did not respond to the drugs. Finally we decided to resect the anterior mass with sternostomy and the pathology report finally resulted in thymoma.

A Huge Anterior Mediastinal Thymoma of an Infant: A Case Report / 임상소아혈액종양

A seven months old male infant visited Severance Children's Hospital for evaluation of anterior mediastinal mass. With chest computed tomography (CT) image and biopsy, precursor T-cell lymphoblastic lymphoma was suspected but the ultrasonography guided biopsy specimen was insufficient to confirm the disease. Because there was a life-threatening risk to perform open biopsy to the small infant, we started chemotherapy empirically. The mass decreased, however, the lesion increased again and did not respond to the drugs. Finally we decided to resect the anterior mass with sternostomy and the pathology report finally resulted in thymoma.

Unusual Thymic Hyperplasia Mimicking Lipomatous Tumor in an Eight-Year-Old Boy with Concomitant Pericardial Lipomatosis and Right Facial Hemihypertrophy

We report a case of thymic hyperplasia accompanied by pericardial lipomatosis and right facial hemihypertrophy in an 8-year-old boy. On imaging studies, the hyperplastic thymus had prominent curvilinear and nodular fatty areas simulating a fat-containing anterior mediastinal mass, which is an unusual finding in children. To our knowledge, this is the first report on a child with a combination of thymic hyperplasia, pericardial lipomatosis, and right facial hemihypertrophy. The radiologic findings are presented with a brief discussion.

Incidental detection of an anterior mediastinal mass during dipyridamole stress Tc-99m sestamibi myocardial perfusion imaging for coronary artery disease

Primary anterior mediastinal neoplasms account for 50% of all mediastinal masses with thymomas being the most common. These tumors demonstrate T1-20 1, Tc-99m sestamibi, and Tcc99m tetrofosmin uptake during SPECT myocardial scintigraphy A 60-year-old Filipino with hypertension, dyslipidemia and prior history of ischemic stroke underwent Tc-99m sestamibi SPECT dipyridamole stress. Inhomogeneous tracer uptake of the left ventricle in the inferior and inferolateral region was noted which was attributed to diaphragmatic attenuation. Gated SPECT showed normal myocardial thickening and wall motion. Extracardiac mediastinal activity was visualized on both the resting and stress images. Computed tomography scan demonstrated two (2) well-defined homogeneously enhancing lesions in the left anterior mediastinum most likely a thymoma. Specialists who interpret myocardial scintigrams should be aware of the causes of non-cardiac uptake so that unanticipated focal extracardiac accumulation during myocardial scintigraphy will lead to further investigation to establish the diagnosis of mediastinal tumors.

Severe hypoxemia and hypotension during general anesthesia of a patient with an anterior mediastinal mass: A case report / 대한마취과학회지

Mediastinal masses may cause compression of vital structures such as major airways, the superior vena cava and, rarely, the pulmonary artery. The latter could cause cardiorespiratory compromise during or after induction of general anesthesia. We observed a case of a 45-year-old woman with an anterior mediastinal mass that caused severe hypoxemia and hypotension during sternotomy for mass resection, probably by pulmonary artery compression. Immediately upon opening the chest to relieve pulmonary artery compression, oxygen saturation and blood pressure returned to normal. Therefore, we suggest that unexpected hypoxemia and hypotension in a patient with a mediastinal mass can be due to pulmonary artery compression.

Anterior Mediastinal Mass with Cavitation / 결핵

Radiological criteria such as smooth, sharply defined interface, obtuse angles between lesion and lung and intimate effect on mediastinal contents were usually used to differentiate mediastinal lesion from parenchymal lung lesion Recently, we experienced a 60-year-old female presenting with anterior mediastinal mass with cavitation. Grossly it was proven to be peripheral lung cancer adjacent to mediastinum and microscopically it was squamous cell carcinoma. The gross pathological findings of surgical specimen were very well correlated with radiological findings. The unique location such as lung periphery and attachment to mediastinum led us to misdiagnosis of anterior mediastinal mass such as germ-cell tumor and neurogenic tumor.