Peri-operative anaesthesia challenges in large anterior mediastinal mass - A case report

Authors : Rachna Wadhwa, Rachna Wadhwa, Varun Sharma, Varun Sharma, Pallavi Ahluwalia, Pallavi Ahluwalia, Vishnu Datt, Vishnu Datt

DOI : 10.18231/j.ijca.2021.128

Volume : 8

Issue : 4

Year : 2021

Page No : 604-607

Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A  45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected. Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.
 

Keywords: Anterior mediastinal mass, Mediastinal widening, Tumor of the thymus.


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