Anterior mediastinal mass in a patient with Graves' disease

We report the first case of a malignant mesothelioma expressing not only granulocyte-colony stimulating factor (G-CSF), but also its receptor. A 59-year-old male carpenter underwent a panpleuropneumonectomy, but the tumor relapsed and spread rapidly, accompanied by leukocytosis. The white blood cell count reached 147,000/mm3 (96.2% neutrophils), and the concentration of serum G-CSF was 77 pg/mL. An autopsy demonstrated that some of the tumor cells produced G-CSF, but more tumor cells and endothelial cells in the tumor expressed G-CSF receptor. It was hypothesized that an autocrine loop involving G-CSF and the G-CSF receptor greatly accelerated the tumor growth.     

Anterior mediastinal mass secondary to histoplasmosis

Histoplasmosis in the mediastinum is an uncommon diagnosis that presents similarly to other benign and neoplastic conditions encountered in the chest. Here we describe a 36-year-old woman who presented with dyspnea secondary to a large anterior mediastinal mass that was biopsy and culture negative for neoplasm or infection. Video-assisted thoracoscopic surgery biopsy confirmed a large anterior mediastinal mass adherent to the aorta, which contained foci of histoplasmosis species. She is currently undergoing a long postoperative course of itraconozole and an empiric course of oral steroids to prevent development of fibrosing mediastinitis.     

Anterior mediastinal mass in a patient susceptible to malignant hyperthermia

We report a malignant hyperthermia- susceptible patient who required investigation for a large, symptomatic anterior mediastinal mass. Multiple attempts at tissue diagnosis under local anaesthesia were unsuccessful. Following awake fibreoptic tracheal intubation, general anaesthesia was administered using ketamine, midazolam, and nitrous oxide, maintaining spontaneous ventilation. Prophylactic dantrolene was not used, to avoid potential muscle weakness and respiratory compromise. Diagnostic mediastinotomy was performed without incident. We conclude that ketamine anaesthesia is appropriate for patients with anterior mediastinal masses, and is considered safe in malignant hyperthermiasusceptible patients. Nous rapportons l’observation d’un patient connu pour sa susceptibilité à l’hyperthermie maligne et qui doit subir une investigation pour une masse médiastinale antérieure symptomatique. De nombreuses tentatives de biopsies diagnostiques ont déjà faites sans succès sous anesthésie locale. A la suite d’une intubation trachéale vigile au fibroscope, une anesthésie générale à la kétamine, au midazolam et au protoxyde d’azote est administrée en ventilation spontanée. On ne donne pas de dantrolène prophylactiquement afin d’éviter une détérioration de la fonction respiratoire par faiblesse musculaire. Une médiastinostomie diagnostique est réalisée sans incident. Nous concluons que l’anesthésie à la kétamine est appropriée pour les porteurs de masses médiatinales antérieures et que cet agent anesthésique ne présente pas de dangers particuliers pour les patients dont la susceptibilité à l’hyperthermie maligne est connue.     

Anterior mediastinal mass with hyperthyroidism; report of a case

The patient was a 27-year-old man who had been diagnosed as having hyperthyroidism and with an anterior mediastinal mass which was reduced in size after anti-thyroid therapy. This mass was thought to be thymic hyperplasia associated with hyperthyroidism. An anterior mediastinal mass accompanying hyperthyroidism should be surgically treated when it dose not regress after an appropriate antithyroid therapy or there is a clinical suspicion of malignancy.     

Anterior mediastinal mass in a pregnant patient: Anesthetic management and considerations

Patients with anterior mediastinal masses are recognized to be at risk for cardiorespiratory compromise when general anesthesia is induced.^1,2 Likewise, pregnancy has a widely known constellation of potential complications that confront the anesthesiologist. The combination of both problems in a single patient presents an unusual anesthetic challenge. The following is a case report of a pregnant patient with a large, symptomatic anterior mediastinal mass who required general anesthesia for a diagnostic procedure before definitive therapy could be initiated.     

Anterior mediastinal abscess diagnosed in a young sumo wrestler after closed blunt chest trauma

Most mediastinal abscesses result from infections after thoracotomy, esophageal perforation or penetrating chest trauma. This disease is rarely caused by closed blunt chest trauma. All previously reported such cases after closed blunt chest trauma presented with hematoma and sternal osteomyelitis resulting from sternal fracture. Here we report a 15-year-old sumo wrestler who presented with an anterior mediastinal abscess without any mediastinal fracture. The mediastinal abscess resulted from the hematogenous spread of Staphylococcus aureus to a hematoma that might have been caused by a closed blunt chest trauma incurred during sumo wrestling exercises.     

Anterior mediastinal tracheostomy with a latissimus dorsi musculocutaneous flap.

We describe the reconstruction of an anterior mediastinal tracheostomy with a latissimus dorsi musculocutaneous flap. This procedure is safer, more easily carried out, a more reliable means of creating an anterior mediastinal tracheostomy and is better suited for chest wound healing than previous methods. In addition, the appearance of the patient's chest after operation is cosmetically excellent.     

Anterior mediastinal abscess complicating septic arthritis.

An 11-year-old boy with septic arthritis of both knees presented with an anterior mediastinal abscess extending suprasternally. This was drained through a suprasternal incision and the mediastinal cavity was intermittently irrigated with povidone iodine solution and packed with gauze. Staphylococcus aureus was the responsible organism. Antibiotic therapy comprised of cloxacillin and gentamycin. Recovery was uneventful. This is, most probably, the first report on an anterior mediastinal abscess complicating a distant septic arthritis. As for any infective mediastinitis, early diagnosis and aggressive treatment is mandatory for a patient's survival.     

Anterior mediastinal presentation of a giant angiomyolipoma

Angiomyolipomas are benign, solitary, noninvasive lesions that most often arise in the kidney. Extrarenal manifestations of these tumors include the skin, oropharynx, the abdominal wall, retroperitoneum, gastrointestinal tract, heart, lung, liver, uterus, penis, and spinal cord. We report a patient with a giant angiomyolipoma located in the anterior mediastinum. We believe this is the seventh reported case of mediastinal angiomyolipoma and the largest reported by size. It is the second reported lesion to arise in the anterior mediastinum. Distinction from other pulmonary or thoracic masses relies on the appreciation of the unique and characteristic histologic features of these mediastinal angiomyolipomas. We conclude that, although rare, angiomyolipoma should be considered in the differential diagnosis of a mediastinal tumor.     

Anterior mediastinal abscess after closed sternal fracture.

BACKGROUND: Although sternal fractures after blunt chest trauma are markers for significant impact, the fracture itself is generally not associated with any specific wound complications. Mediastinal abscess and sternal osteomyelitis rarely occur after blunt trauma or cardiopulmonary resuscitation. Management of such complications is difficult, and requires a spectrum of operative procedures that range from simple closure to muscle flap reconstruction. METHODS: The trauma registry of a Level I trauma center was used to identify patients suffering a sternal fracture between January of 1994 and August of 1997. Records were reviewed for the mechanism of injury, length of hospital stay, and posttraumatic mediastinal abscess. RESULTS: Twenty-six patients were identified with sternal fracture. No clinically significant cardiac or aortic complications were noted. Three patients, all with a history of intravenous drug abuse and requiring central venous access in the emergency room, developed methicillin resistant Staphylococcus aureus mediastinitis. Sternal re-wiring and placement of an irrigation system successfully treated all three patients. CONCLUSION: Posttraumatic mediastinal abscess is an uncommon complication of blunt trauma in general and sternal fracture in particular. It can be recognized by the development of sternal instability. Risk factors include the presence of hematoma, intravenous drug abuse, and source of staphylococcal infection. Treatment with early debridement and irrigation can avoid the need for muscle flap closure.     

Metastatic thyroid cancer manifesting as a mediastinal mass in a man with an aberrant right subclavian artery

We treated a case of thyroid cancer manifesting as a mediastinal mass, completely resecting it without difficulty despite a vascular anomaly. An asymptomatic 42-year-old woman was admitted with a mediastinal mass. Ten years earlier, she had undergone surgery for a thyroid tumor diagnosed as follicular adenoma. She also had an aberrent subclavian artery anomaly with a non-recurrent laryngeal nerve, radiographically recognized preoperatively. The mediastinal mass was completely resected through median sternotomy. Pathological examination showed the previous thyroid tumor had been follicular carcinoma, and that the mass was a mediastinal-node metastasis from the thyroid cancer. Preoperative recognition of the vascular anomaly was helpful in completing resection, in addition to safe, quick surgical procedures.