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Anaesthesia for emergency caesarean section in a patient with large anterior mediastinal tumour presenting as intrathoracic airway compression and superior vena cava obstruction.

Chiang JC, Irwin MG, Hussain A, Tang YK, Hiong YT - Case Rep Med (2010)

Bottom Line: Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise.We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction.The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Queen Mary Hospital, Hong Kong.

ABSTRACT
Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise. We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction. The patient had emergency Caesarean section under epidural anaesthesia with a good outcome. The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions.

No MeSH data available.


Related in: MedlinePlus

Chest X-ray was taken with abdominal shield. There was a huge mass occupying the left chest; trachea is deviated to the right. The mass caused loss of volume in left lung and elevated left hemidiaphragm.
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fig1: Chest X-ray was taken with abdominal shield. There was a huge mass occupying the left chest; trachea is deviated to the right. The mass caused loss of volume in left lung and elevated left hemidiaphragm.

Mentions: An arterial blood sample breathing supplemental nasal oxygen at 2 L/min showed a pH 7.48, pO2 15.0 kPa, pCO2 3.8 kPa, and base excess −2 mmol/L. There was no anaemia or electrolyte abnormality. Electrocardiogram was normal. Chest X-ray (in upright position, Figure 1) and computerised tomography of thorax (in left lateral position which could be barely tolerated by the dyspnoeic patient, Figure 2) were performed on the day of admission. There was a lobulated anterior mediastinal mass sized 16.5 × 9.9 × 10 cm and extended into the left hemithorax. The mass was heterogenous in enhancement and had internal hypodense areas suggestive of necrosis. The trachea and carina were compressed against the spinal column. The left main bronchus was stenosed and accounted for volume loss and atelectasis in the lower lobe of the left lung. There was a small left pleural effusion. The heart was pushed against the diaphragm, and there was also a pericardial effusion. The superior vena cava was stretched and compressed. The left subclavian vein was dilated and tortuous, and the left brachiocephalic trunk was compressed against the sternum. Fine needle aspiration of the mediastinal mass was suspicious of malignancy, and biopsy was advised for histological evaluation. Foetal cardiotocograph showed no abnormality. At that time, the provisional diagnosis was a malignant thymoma or lymphoma.


Anaesthesia for emergency caesarean section in a patient with large anterior mediastinal tumour presenting as intrathoracic airway compression and superior vena cava obstruction.

Chiang JC, Irwin MG, Hussain A, Tang YK, Hiong YT - Case Rep Med (2010)

Chest X-ray was taken with abdominal shield. There was a huge mass occupying the left chest; trachea is deviated to the right. The mass caused loss of volume in left lung and elevated left hemidiaphragm.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2957859&req=5

fig1: Chest X-ray was taken with abdominal shield. There was a huge mass occupying the left chest; trachea is deviated to the right. The mass caused loss of volume in left lung and elevated left hemidiaphragm.
Mentions: An arterial blood sample breathing supplemental nasal oxygen at 2 L/min showed a pH 7.48, pO2 15.0 kPa, pCO2 3.8 kPa, and base excess −2 mmol/L. There was no anaemia or electrolyte abnormality. Electrocardiogram was normal. Chest X-ray (in upright position, Figure 1) and computerised tomography of thorax (in left lateral position which could be barely tolerated by the dyspnoeic patient, Figure 2) were performed on the day of admission. There was a lobulated anterior mediastinal mass sized 16.5 × 9.9 × 10 cm and extended into the left hemithorax. The mass was heterogenous in enhancement and had internal hypodense areas suggestive of necrosis. The trachea and carina were compressed against the spinal column. The left main bronchus was stenosed and accounted for volume loss and atelectasis in the lower lobe of the left lung. There was a small left pleural effusion. The heart was pushed against the diaphragm, and there was also a pericardial effusion. The superior vena cava was stretched and compressed. The left subclavian vein was dilated and tortuous, and the left brachiocephalic trunk was compressed against the sternum. Fine needle aspiration of the mediastinal mass was suspicious of malignancy, and biopsy was advised for histological evaluation. Foetal cardiotocograph showed no abnormality. At that time, the provisional diagnosis was a malignant thymoma or lymphoma.

Bottom Line: Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise.We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction.The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Queen Mary Hospital, Hong Kong.

ABSTRACT
Anterior mediastinal mass is an uncommon pathology that presents significant anaesthetic challenges because of cardiopulmonary compromise. We present a case that presented in the third trimester of pregnancy with severe breathlessness, orthopnoea, and symptoms of superior vena cava obstruction. The patient had emergency Caesarean section under epidural anaesthesia with a good outcome. The paper discusses the relevant perioperative considerations for this complex scenario and reviews reports of similar conditions.

No MeSH data available.


Related in: MedlinePlus