Mediastinal Masses

Usually a congenital lesion, occurring at 1:5000; no gender bias

Benign or malignant; cysts or aneurysms that arise from the lung, pleura, or another structure of anterior mediastinum; middle mediastinum: LN enlargement and vascular masses, posterior mediastinum: neurogenic tumors and esophageal abnormalities. In children, neurogenic tumors or cysts are common.

Lymphoma (Hodgkin or NHL), thymoma, germ cell tumor, granuloma, bronchogenic cancer, thyroid tumors (retrosternal goiter), bronchogenic cysts, and cystic hygroma.

Periop mortality is rare.

Sudden CV collapse from inability to ventilate or oxygenate.

Hypotension or tamponade.

Increased dyspnea (orthopnea) or cough when supine (increased risk of airway complications).

Syncopal symptoms or pericardial effusion (increased risk of CV complications).

Major airway complications in these pts are now more likely to occur in the postanesthetic care area rather than in the OR.

Inability to get on cardiopulmonary bypass rapid enough to avoid permanent neurologic damage

Superior vena cava syndrome with airway edema and increased bleeding

Recurrent laryngeal nerve injury

Pts at risk with cough and pain, dyspnea and dysphagia, superior vena cava syndrome, tracheal deviation, Horner syndrome, cyanosis, mediastinal widening, and hoarseness

Severity of symptoms does not predict intraop course.

Airway obstruction or hemodynamic compromise has occurred with induction of GA, intubation, muscle relaxation, position change, and after extubation.

Pts may present with Sx that include chest pain or fullness, dyspnea, cough, sweats, superior vena cava obstruction, hoarseness, syncope, or dysphagia.

Pts can be asymptomatic and have a mass diagnosed on a screening chest radiograph or CT scan.