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Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency.

Simoncic M, Kopriva S, Zupancic Z, Jerse M, Babnik J, Srpcic M, Grosek S - Radiol Oncol (2014)

Bottom Line: Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period.Histology examination revealed an encapsulated immature teratoma.Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.

ABSTRACT

Background: Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultra-sound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period.

Case report: A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months.

Conclusion: This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

No MeSH data available.


Related in: MedlinePlus

Chest x-ray after birth demonstrates large round tumour in the right hemithorax. (6 × 7 cm) with deviation of mediastinal structures to the left. Soft tissues of the thoracic wall are oedematous.
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f2-rado-48-04-397: Chest x-ray after birth demonstrates large round tumour in the right hemithorax. (6 × 7 cm) with deviation of mediastinal structures to the left. Soft tissues of the thoracic wall are oedematous.

Mentions: An initial arterial blood gas analysis revealed a respiratory acidosis with a pH of 6.91, PaCO2 19 kPa and HCO3 of 13 mmol/l. US revealed anterior mediastinal cystic mass extending into the right and left hemithorax with marked pleural effusion bilaterally. Chest X-ray confirmed a homogenous mass in the anterior right hemithorax with shifting of the mediastinum to the left (Figure 2). Ductus arteriosus with left to right shunt was still patent. Because of pleural effusion pleural puncture was performed, further complicated by pneumothorax. Despite ventilation with high frequent oscillations respiratory acidosis still persisted with PCO2 between 10 and 15 kPa. Due to low blood pressure (mean arterial pressure 4 kPa) and very poor urine output he needed vasoactive support with dopamin and dobutamine. US of the heart showed signs of pulmonary artery hypertension. The diagnosis based on radiological finding was congenital cystic adenomatoid malformation, which needed surgical excision on day seven of life.


Mediastinal teratoma with hydrops fetalis in a newborn and development of chronic respiratory insufficiency.

Simoncic M, Kopriva S, Zupancic Z, Jerse M, Babnik J, Srpcic M, Grosek S - Radiol Oncol (2014)

Chest x-ray after birth demonstrates large round tumour in the right hemithorax. (6 × 7 cm) with deviation of mediastinal structures to the left. Soft tissues of the thoracic wall are oedematous.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4230561&req=5

f2-rado-48-04-397: Chest x-ray after birth demonstrates large round tumour in the right hemithorax. (6 × 7 cm) with deviation of mediastinal structures to the left. Soft tissues of the thoracic wall are oedematous.
Mentions: An initial arterial blood gas analysis revealed a respiratory acidosis with a pH of 6.91, PaCO2 19 kPa and HCO3 of 13 mmol/l. US revealed anterior mediastinal cystic mass extending into the right and left hemithorax with marked pleural effusion bilaterally. Chest X-ray confirmed a homogenous mass in the anterior right hemithorax with shifting of the mediastinum to the left (Figure 2). Ductus arteriosus with left to right shunt was still patent. Because of pleural effusion pleural puncture was performed, further complicated by pneumothorax. Despite ventilation with high frequent oscillations respiratory acidosis still persisted with PCO2 between 10 and 15 kPa. Due to low blood pressure (mean arterial pressure 4 kPa) and very poor urine output he needed vasoactive support with dopamin and dobutamine. US of the heart showed signs of pulmonary artery hypertension. The diagnosis based on radiological finding was congenital cystic adenomatoid malformation, which needed surgical excision on day seven of life.

Bottom Line: Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period.Histology examination revealed an encapsulated immature teratoma.Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

View Article: PubMed Central - PubMed

Affiliation: Department of Pediatric Surgery and Intensive Care, University Medical Centre Ljubljana, Ljubljana, Slovenia.

ABSTRACT

Background: Mediastinal fetal teratoma can be detected as a mass in the chest during a routine prenatal ultra-sound screening. Because of the pressure on mediastinal structures it can be the cause of non-immune hydrops fetalis and polyhydramnion. The development of hydrops fetalis leads to fetal death or premature delivery in most reported cases. Early surgical removal is important, but, the result of treatment depends on the stage of development of mediastinal organs and complications in the postoperative period.

Case report: A 31-year-old gravida carrying twins, with spontaneous membrane rupture at 32 weeks gestation underwent urgent caesarean section after antenatal ultrasound revealed severe polyhydramnion and hydrops fetalis in geminus A. The child was intubated immediately after birth due to severe respiratory distress. Ultrasound and X-ray revealed a tumour mass in the right hemithorax. Tumour resection was performed at the age of 7 days. Histology examination revealed an encapsulated immature teratoma. The postoperative course was complicated with respiratory insufficiency which turned into chronic at the age of eight months.

Conclusion: This is the fifth reported child with fetal mediastinal teratoma and severe hydrops fetalis that survived the neonatal period. Additional diagnostic search revealed abnormal course of both pulmonary arteries, which was probably one of the main causes of respiratory insufficiency.

No MeSH data available.


Related in: MedlinePlus