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

Abstract

Literature on posterior mediastinal masses is limited. Furthermore, they have traditionally been described to pose lower cardiopulmonary risks compared with anterior mediastinal masses. Studies on posterior mediastinal masses are even more limited in the pediatric population. We present a case of a large posterior mediastinal mass in a 4-year-old child who presented with extremely difficult airway management during endobronchial intubation due to severe external compression that led to use of an adapted airway management technique with a rigid airway exchanger for lung isolation. Due to the pathology of the mass, a tracheal tear was encountered during surgical dissection and the patient required emergent venovenous extracorporeal membrane oxygenation to allow for successful airway repair and complete resection of the mass.

A Child with a Large Posterior Mediastinal Mass with Intraspinal Extension—Perioperative Anesthetic Challenges and Importance of Postoperative Analgesia

“…[1][2][3][4][5][6][7] Children with large posterior mediastinal tumors with intraspinal extension pose many challenges for an anesthesiologist because of their size, location, and invasiveness. [1][2][3][4][5][6][7] The various challenges include difficult intubation, ventilation, hemodynamic fluctuations because of tumor compression on vital structures, associated autonomic dysfunction with intraspinal extension, and intraoperative bleeding. In addition, obtaining the MEP response with poor functional grading, isolating one lung for thoracotomy and excision in small children with bronchial compression, and appropriate techniques for perioperative analgesia in children with neurological deficits are some of the additional challenges we faced in this case.…”

“…They are asymptomatic initially and hence present as large mediastinal masses. [1][2][3][4][5][6][7] Children with large posterior mediastinal tumors with intraspinal extension pose many challenges for an anesthesiologist because of their size, location, and invasiveness. [1][2][3][4][5][6][7] The various challenges include difficult intubation, ventilation, hemodynamic fluctuations because of tumor compression on vital structures, associated autonomic dysfunction with intraspinal extension, and intraoperative bleeding.…”

Extracorporeal life support in thoracic emergencies—a narrative review of current evidence

“…ECLS in V-A configuration is used as a rescue management of anterior mediastinal masses with extrinsic compression on the airways and mediastinal vessels as well as during an emergent peri-arrest setting (17)(18)(19)(20).…”