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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 demonstrates high position of the right diaphragm due to postoperative paralysis.
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f6-rado-48-04-397: Chest x-ray demonstrates high position of the right diaphragm due to postoperative paralysis.

Mentions: Hydropic oedemas subsided three days after operation. Urine output and hemodynamic parameters were stable and we discontinued the vasoactive drug support one week after operation. Postoperative course was complicated by a spontaneous pneumothorax on the right side and a sepsis caused by Staphylococcus epidermidis. Fifteen days after operation, the newborn still needed support with synchronized intermittent mandatory ventilation. He had multiple spontaneous episodes of oxygen desaturation. We performed diagnostic rigid bronchoscopy with which we excluded changes in the bronchial system. US of the heart showed signs of pulmonary artery hypertension, persistent ductus arteriosus and patent foramen ovale. We started treatment with nitric oxide and selective inhibitor of phosphodiesterase type 5, with no improvement. Chest X-ray revealed hyperinflation of the left lung and high position of the diaphragm on the right side (Figure 6).


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 demonstrates high position of the right diaphragm due to postoperative paralysis.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

f6-rado-48-04-397: Chest x-ray demonstrates high position of the right diaphragm due to postoperative paralysis.
Mentions: Hydropic oedemas subsided three days after operation. Urine output and hemodynamic parameters were stable and we discontinued the vasoactive drug support one week after operation. Postoperative course was complicated by a spontaneous pneumothorax on the right side and a sepsis caused by Staphylococcus epidermidis. Fifteen days after operation, the newborn still needed support with synchronized intermittent mandatory ventilation. He had multiple spontaneous episodes of oxygen desaturation. We performed diagnostic rigid bronchoscopy with which we excluded changes in the bronchial system. US of the heart showed signs of pulmonary artery hypertension, persistent ductus arteriosus and patent foramen ovale. We started treatment with nitric oxide and selective inhibitor of phosphodiesterase type 5, with no improvement. Chest X-ray revealed hyperinflation of the left lung and high position of the diaphragm on the right side (Figure 6).

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