When is a mediastinal mass critical in a child? An analysis of 29 patients

Abstract

The aims of this study were to determine the pattern of presentation of childhood mediastinal masses in our community and to identify factors associated with the development of acute airway compromise. The authors retrospectively reviewed the records of 29 consecutive patients with mediastinal masses managed at their institution between January 1995 and December 2001. Demographic data, mass characteristics, clinical presentation, and surgical procedures were recorded. Seven patients (24.1%) were asymptomatic at presentation. Eight (27.6%) were classified as having acute airway compromise at presentation. Respiratory symptoms and signs were the most common mode of presentation (58.6% and 55.2%, respectively). The most common histological diagnosis was neurogenic mass (37.9%), followed by lymphoma (24.1%). Most masses were located in the superior mediastinum (41.1%). Factors associated with the development of acute airway compromise were (1) anterior location of the mediastinal mass (P=0.019), (2) histological diagnosis of lymphoma (P=0.008), (3) symptoms and signs of superior vena cava syndrome (P=0.015 and 0.003, respectively), (4) radiological evidence of vessel compression or displacement (P=0.015), (5) pericardial effusion (P=0.015), and (6) pleural effusion (P=0.033). Clinical presentation of childhood mediastinal masses is often nonspecific or incidental. Yet they have the propensity of developing acute airway compromise, which is closely associated with superior vena cava obstruction. Such patients should be managed as a complex cardiorespiratory syndrome, termed "critical mediastinal mass syndrome", by an experienced multidisciplinary team.

Mediastinal masses masquerading as common respiratory conditions of childhood: a case series

“…Without timely investigation and intervention, this may proceed to critical airway compression and, ultimately, respiratory arrest [6,9]. In one series of 29 patients with mediastinal masses, the incidence of acute airway compromise at presentation was 28% [6]. A short history, highly suggestive of either T-ALL or T-NHL, requires emergency referral and investigation, whilst a more insidious history, often of many months, is more likely to represent HL or other (rare) solid tumours [4].…”

“…Progressive airway obstruction secondary to external lymph node compression may result in stridor, cough, wheeze and/or shortness of breath [5]. Without timely investigation and intervention, this may proceed to critical airway compression and, ultimately, respiratory arrest [6,9]. In one series of 29 patients with mediastinal masses, the incidence of acute airway compromise at presentation was 28% [6].…”

Unrecognized Mediastinal Tumor Causing Sudden Tracheal Obstruction and Out-of-Hospital Cardiac Arrest

“…Unlike in adults, mediastinal tumors in children may grow rapidly over days, causing severe airway obstruction (1). However, sudden cardiopulmonary arrest, as described in this article, is an exceptional presentation of hematologic malignancies in children.…”

Mediastinal Masses: Pathophysiological Issues and Management Challenges in a Developing World

“…While an earlier report from Ibadan, southwest Nigeria confirmed lymphomas as the commonest primary mediastinal masses, [7] Lam and his colleagues [6] in Singapore found neurogenic tumour as the commonest his-tologic variant. Some of the rare tumours of the mediastinum include sarcoma of follicular dendritic cells in the posterior mediastinum, non seminomatous germ cell tumour, adenomatoid tumour, mediastinal extramedullary haemopoietic tumour, thoracic duct cysts and cervicothoracic schwannoma.…”

“…Ankermann and his colleagues [5] found three paediatric cases that presented like bronchial asthma. Critical mediastinal mass with propensity to cause respiratory symptoms in children is associated with the followings: anterior location of the mediastinal mass, histological diagnosis of lymphoma, presence of superior vena caval obstruction, radiological evidence of vessel compression or displacement, pericardial effusion and pleural effusion [6].…”