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- Title
When is a mediastinal mass critical in a child? An analysis of 29 patients.
- Authors
Lam, J. C. M.; Chui, C. H.; Jacobsen, A. S.; Tan, A. M.; Joseph, V. T.
- 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.
- Subjects
MEDIASTINUM; SURGERY; RESPIRATORY organs; SYMPTOMS; LYMPHOMAS; PLEURAL effusions; MEDIASTINUM diseases; MEDIASTINAL tumors; RESPIRATORY obstructions; RETROSPECTIVE studies; DISEASE complications; SUPERIOR vena cava syndrome; PREVENTION; DIAGNOSIS; THERAPEUTICS; TUMOR treatment
- Publication
Pediatric Surgery International, 2004, Vol 20, Issue 3, p180
- ISSN
0179-0358
- Publication type
journal article
- DOI
10.1007/s00383-004-1142-6