Eur J Pediatr Surg 2011; 21(5): 310-313
DOI: 10.1055/s-0031-1279745
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Management of Anterior Mediastinal Masses in Children

C. L. Garey2 , C. A. Laituri2 , P. A. Valusek2 , S. D. St. Peter3 , C. L. Snyder1
  • 1Children's Mercy Hospital, Department of Surgery, Kansas City, United States
  • 2Children's Mercy Hospital and Clinics, Pediatric Surgery, Kansas City, United States
  • 3Children's Mercy Hospital, Department of Surgery, Center for Prospective Trials, Kansas City, United States
Further Information

Publication History

received February 16, 2011

accepted after revision April 29, 2011

Publication Date:
12 July 2011 (online)

Abstract

Background: Children with anterior mediastinal masses are at risk for life-threatening airway compromise during anesthesia, and can present a diagnostic and management challenge for pediatric surgeons.

Methods: We performed a retrospective chart review of all children presenting with an anterior mediastinal mass from 1994–2009. Parameters studied included demographics, historical and physical findings at diagnosis, radiographic evidence of airway compression, diagnostic studies, diagnosis, and complications.

Results: There were 26 patients with anterior mediastinal masses over a 15-year period. The mean age was 11.3 years, and there were no gender differences. The diagnoses were lymphoma (62%, 16/26), leukemia (15%, 4/26), and other (23%, 6/26). Diagnosis was made by CBC/peripheral smear in 2/4 patients with leukemia, by bone marrow biopsy in 2/4 patients with leukemia, by thoracentesis in 3/16 patients with lymphoma, by lymph node biopsies in 6/16 patients with lymphoma, and by biopsy of a mediastinal mass in 7/16 patients with lymphoma and in 6/6 patients with other diagnoses. Radiographic evidence of airway compression was seen in 62% (16/26) of children. Only 12% (3/26) had a tracheal cross-sectional area (TCA) <50%. Correlation of symptoms with anatomical airway obstruction or complications was poor. Pulmonary function studies were obtained in 38%, 10/26 children. Only 2 children had a PEFR (peak expiratory flow rate) <50% predicted. This data also correlated poorly with anatomical airway obstruction or complications. 3 patients had anesthesia-related complications: one desaturation during induction prior to median sternotomy, one with significant desaturation and bradycardia during biopsy under local anesthesia with minimal sedation, and one with prolonged (5 days) mechanical ventilation after general anesthesia. 2 of these patients had a TCA <50%, and 2 had SVC obstructions. There were no anesthesia-related deaths, and the overall survival was 85% (22/26).

Conclusion: Anterior mediastinal masses in children should be approached in a step-wise fashion with multi-disciplinary involvement, starting with the least invasive techniques and progressing cautiously. The surgeon should have a well-defined and preoperatively established contingency plan if these children require general anesthesia for diagnosis.

References

Correspondence

Dr. Charles L. Snyder, MD 

Children's Mercy Hosptial

Department of Surgery

24th and Gillham Rd

Kansas City

United States 64108

Phone: + 1 816 234 35 76

Fax: + 1 913 983 63 71

Email: csnyder@cmh.edu