Anterior mediastinal masses — A multidisciplinary pathway for safe diagnostic procedures

Malik, Rubina; Mullassery, Dhanya; Kleine‐Brueggeney, Maren; Atra, Ayad; Gour, Anami; Sunderland, Robin; Okoye, Bruce

doi:10.1016/j.jpedsurg.2018.10.080

Cited by 34 publications

(32 citation statements)

References 22 publications

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“…If there was no pleural effusion, we performed core needle biopsy under local anesthesia to maintain spontaneous breathing [3]. Acute lymphoblastic leukemia is also noted among anterior mediastinal tumors [2] and is usually suspected based on peripheral blood smear test results. At our hospital, peripheral blood and bone marrow smears are routinely prepared for patients with suspected hematologic malignancy and those with solid tumor requiring evaluation for bone marrow metastases such as neuroblastoma.…”

Section: Discussionmentioning

confidence: 99%

“…In patients with respiratory distress whose bronchus is compressed by a mediastinal tumor, respiratory failure is likely to occur, especially when muscle-relaxant drugs are used for general anesthesia or mechanical ventilation [1]. Therefore, avoiding tumor biopsies for mediastinal tumors under general anesthesia has been recommended; the use of alternative diagnostic methods has also been advocated [2].…”

Section: Introductionmentioning

confidence: 99%

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Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience

et al. 2020

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Background: The fundamental treatment for patients with pediatric malignant mediastinal tumors is chemotherapy. Therefore, accurate diagnosis is essential for selecting the appropriate chemotherapeutic regimen. However, malignant mediastinal tumors occasionally cause respiratory distress, and biopsies under general anesthesia are dangerous for such patients as invasive mechanical ventilation can aggravate airway obstruction caused by mass effect. In this study, we reviewed our 10-year diagnostic experience to evaluate the efficacy of our practices and confirm a safe diagnostic protocol for future patients. Methods: We retrospectively reviewed medical records of children with malignant mediastinal tumors diagnosed at Nagoya University Hospital from 2007 to 2018 who demonstrated respiratory distress. Respiratory distress included dyspnea, massive pleural effusion, wheezing, and hypoxemia owing to tumors. Data on sex, age at onset, primary symptoms, location of tumor, management strategy (especially the method of diagnosis and definitive diagnosis), clinical course, prognosis during the acute phase (within 3 months from the onset of respiratory symptoms), and long-term outcome were collected. Results: Twelve pediatric patients met the review criteria. There were seven anterior mediastinal tumors and five posterior mediastinal tumors. All anterior mediastinal tumors were diagnosed via bone marrow smear, thoracentesis, or core needle biopsy while maintaining spontaneous breathing. Regarding posterior tumors, two patients were diagnosed via a core needle biopsy and lymph node excisional biopsy under spontaneous breathing. Two cases were initially diagnosed solely using tumor markers. One patient with severe tracheal compression underwent tumor resection with extracorporeal membrane oxygenation stand-by. No patient died of diagnostic procedure-related complications. Conclusions: In 11 of the 12 cases reviewed, safe and accurate tumor diagnosis was accomplished without general anesthesia. A diagnostic strategy without general anesthesia considering the tumor location proved to be useful.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience

et al. 2020

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“…CT or MRI may be used to image these tumors. Multidisciplinary preoperative assessment is essential, because decisions about which tissue to biopsy (and anesthetic technique) may be quite complicated (30).…”

Section: Other Extrinsic Compressionmentioning

confidence: 99%

Imaging of Airway Obstruction in Children

2020

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Various imaging techniques may be used to diagnose airway obstruction in children. Digital radiography, computed tomography and magnetic resonance imaging are the most important modalities, but the choice of technique will depend on the level and nature of suspected obstruction, as well as patient-specific factors such as age and ability to cooperate. This review examines the forms of airway obstruction that are commonly encountered in childhood.

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“…Mediastinaltumoren können eine erhebliche Größe annehmen, ohne je klinische Symptome hervorzurufen [6,7] Intraoperative Verletzungen der großen Gefäße können so gut versorgt werden. Ist der Tumor von der Mittellinie mehr nach rechts oder links gekippt, so kann ein Hemi-Clamshell-Zugang durchgeführt werden (▶ Abb.…”

Section: Klinische Beschwerdenunclassified

Allgemeine Übersicht zu Mediastinaltumoren: Einteilung, Zugangswege, Biopsie

Kirschbaum

2020

Zentralbl Chir

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ZusammenfassungMediastinaltumoren können für das Behandlungsteam hinsichtlich der Diagnostik und Therapie eine echte Herausforderung darstellen. Dies liegt u. a. an dem weiten Spektrum an Tumorarten. Viele Betroffene sind zum Zeitpunkt der Diagnosestellung völlig asymptomatisch trotz erheblicher Tumorgröße. In der räumlichen Zuordnung zu einem mediastinalen Kompartiment kann i. d. R. die Tumorart schon eingeschränkt werden. Ziel ist es jedoch, die Diagnose über eine Punktion oder eine Biopsie zu sichern. Dazu stehen verschiedene Verfahren zur Verfügung. Anhand der räumlichen Lage und der Ausdehnung in der Bildgebung muss der optimale Zugangsweg für die operative Entfernung eines Mediastinaltumors geplant werden. Nur so kann eine risikoarme und komplette Entfernung der Mediastinaltumoren gewährleistet werden.

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Anterior mediastinal masses — A multidisciplinary pathway for safe diagnostic procedures

Cited by 34 publications

References 22 publications

Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience

Safe diagnostic management of malignant mediastinal tumors in the presence of respiratory distress: a 10-year experience

Imaging of Airway Obstruction in Children

Allgemeine Übersicht zu Mediastinaltumoren: Einteilung, Zugangswege, Biopsie

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