Anaesthetic management of posterior mediastinal mass: a case report

Resection of a Posterior Mediastinal Mass in a 4-Year-Old Child Complicated by Difficult Airway Management and Emergent Use of Extracorporeal Membrane Oxygenation

“…The most common causes of posterior mediastinal masses for the adult and pediatric population are neurogenic tumors, 4 followed by lymphoma and mediastinal cysts. 5 Enteric duplication cysts, as found in our patient, are rare developmental anomalies originating from the alimentary tract with a reported incidence of 1:4500. 6 Most are detected in children antenatally or within the first 2 years of life.…”

“…10,11 Infants and small children may be more susceptible than adults to external airway obstruction because their cartilaginous airways are more compressible 1 and due to their relatively small thoracic cavity. 5,11 Additionally, small decreases in airway diameter create a relatively larger decrease in overall luminal area and increase in airway resistance. 1 Preoperative evaluation of cardiopulmonary risk in patients of all ages with mediastinal masses should focus on a combination of clinical and diagnostic findings.…”

“…Diagnostic imaging showed severe main-stem bronchus compression, which elevated her intraoperative risk. 14 Given the significant risks for anesthesia-related morbidity and mortality for patients with posterior mediastinal masses as supported predominantly by case reports, 3,5,[7][8][9][15][16][17] identifying clinical predictors would be desirable in order to optimize outcome. However, only very few studies have tried to identify risk factors for adverse anesthetic outcomes in patients with posterior masses specifically.…”

“…13 A few case reports describe the anesthetic management of posterior mediastinal mass resection in adults. 3,[7][8][9]15,16,[23][24][25][26]27 A single-center experience of 5 patients 28 and a handful of case reports 5,17,29,30 describe the symptoms, management, and complications associated with posterior mediastinal masses in pediatric patients. Based on these pediatric case reports, clinical presentation, management, and potential complications vary.…”

“…Based on these pediatric case reports, clinical presentation, management, and potential complications vary. Patients aged 3 to 14 years present with dyspnea 5,29 (may be positional), 29 cyanosis, 17 fever, 5,30 or pneumonia, 30 only occasionally causing airway compression. [28][29][30] The majority of the cases requiring surgical resection were performed through open thoracotomy.…”