Acute respiratory distress caused by a giant mediastinal lipoblastoma in a 16-month-old boy

Lipoblastoma is a rare benign tumor arising from embryonic fat; it occurs mainly in the extremities and almost exclusively in infants and children younger than 3 years. We present a case of giant mediastinal lipoblastoma in a 16-month-old boy who presented with acute respiratory distress. The mass was completely excised through a left posterolateral thoracotomy. The postoperative course was uneventful, and the pathologic final diagnosis was lipoblastoma. Although extremely rare, mediastinal lipoblastoma can be life threatening; therefore, it should be included in the differential diagnosis of mediastinal mass in younger subjects.     

Versatility of a mini-trapdoor incision in upper mediastinal exposure

Exposure of the upper mediastinum and thoracic outlet can pose major surgical challenges. We report our application of a previously described mini-trapdoor incision to a variety of surgical problems involving the upper mediastinum and thoracic outlet, including subclavian vein thrombosis, penetrating subclavian artery injury, debridement of subjacent chest wall infection, lymph node excision, and Pancoast tumor resection. This versatile approach provides excellent structural visualization while obviating clavicular resection or sternoclavicular joint disruption, or both.     

Successful thoracoscopic resection of a large mediastinal liposarcoma

We report a case of a rare, large mediastinal liposarcoma diagnosed in a 74-year-old woman after a syncopal episode. Chest roentgenogram and computed tomographic scan showed a large mass occupying most of the right chest and abutting the great vessels and pericardium. A thoracoscopic approach was used for exploration and surgical excision of this large mediastinal mass. Despite the large size of the mass, the thoracoscopic approach offered excellent visualization of all the mass attachments and required only a small extension of the access incision for tumor removal. The mass was a well-differentiated liposarcoma, which was completely resected with clear margins. The patient remains disease-free almost 3 years after the resection.     

Cystoperitoneal shunt for a giant intrathoracic meningocele under local anesthesia

Giant intrathoracic meningoceles are extremely rare, and the standard treatment for giant intrathoracic meningoceles remains controversial. We present the case of a patient with giant intrathoracic meningoceles associated with neurofibromatosis type I. Our patient had poor respiratory function because of the giant intrathoracic meningocele, so we performed a cystoperitoneal shunt under local anesthesia. We describe our cystoperitoneal shunt technique using an adjustable-pressure valve. This simple, minimally invasive treatment is a valuable alternative treatment option in patients at high operative risk, especially those with low respiratory function.     

Complete resection of a mediastinal solitary extramedullary plasmacytoma and reconstruction of right pulmonary artery and superior vena cava

Solitary extramedullary plasmacytoma located in the thorax is a rare tumor. We present a 21-year-old patient who was diagnosed with a mediastinal solitary extramedullary plasmacytoma. Complete resection of the tumor with reconstruction of the right pulmonary artery and superior vena cava was performed. The patient is alive without evidence of recurrence 8 months after the operation. Extensive resection and reconstructive surgery with the addition of radiotherapy can prolong the patient's life.     

Sternoclavicular osteomyelitis: a new complication of misplaced tracheostomy tube

We report a patient who presented with erythema and swelling over the chest and neck several days after the placement of a tracheostomy tube. Sternoclavicular osteomyelitis and anterior mediastinal abscess occurred, as complications of inadvertent pretracheal tracheostomy tube placement, which were treated with right sternoclavicular resection and mediastinal drainage.