A 30-year-old woman with intermittent cough and a mass-like opacity in the right upper lobe

Anterior Mediastinal Mass Causing Intermittent Atrial Fibrillation

Mediastinal masses are a rare finding in the emergency department and typically present with vague chest complaints such as chest discomfort, chest pain, or dyspnea. Rarely do these tumors present with dysrhythmias, and when dysrhythmias are present, they typically arise secondary to endocrine or metabolic effects exerted by the tumor. Here we report a case of a patient who presented to the emergency department with atrial fibrillation with rapid ventricular response, concomitant with a history of recurrent palpitations that were previously aborted with self-induced vagal maneuvers. Upon further investigation, the patient had an anterior mediastinal mass, diagnosed as a thymoma, suspected to be contributing to his presenting dysrhythmia through mass effect.

Intraoperative Catastrophe during Benign Mediastinal Tumor Mass Excision: A Case Report

Mature teratoma of the mediastinum poses a significant surgical challenge due to close vicinity to vital structures causing respiratory insufficiency or hemodynamic compromise. While the malignant variety of germ cell tumors (GCT) generally present with florid symptoms, benign teratomas are detected incidentally on imaging. Large teratomas presenting as mediastinal mass syndrome have additional difficulty in airway access. Herein, we report a case of a 40-year-old-female with no significant comorbidities presenting with rapidly progressing symptoms of chest pain, dyspnea, and superior vena cava (SVC) compression. Computed tomography (CT) scan of the neck and chest confirmed a large cystic lesion with marked compression of the great veins in the neck, arch of aorta, trachea, and proximal bronchial divisions. Airway access intraoperatively was done by awake fiberoptic bronchoscopy. However, sudden hypoxia and hemodynamic deterioration warranted emergency sternotomy. Adequate preoperative preparation, as well as standby extracorporeal circulatory support, led to successful and complete excision of the tumor. The patient had an uneventful recovery and extubated in the intensive care unit (ICU) the next day. Histopathology of the mass confirmed to be mature benign cystic teratoma. At six-month follow-up, the patient was completely asymptomatic without any complications. The impact of intraoperative catastrophe on the healthcare team can be immense. Inability to achieve a secure airway and the resultant hypoxia can result in permanent neurological damage. A multidisciplinary approach leading to adequate preoperative assessment, intraoperative preparedness for an emergency sternotomy with standby extracorporeal circulatory support due to the risk of mediastinal mass syndrome, were key features in the successful management of the patient.

A symptomatic anterior mediastinal mass with a simultaneous Haemophilus influenzae infection

Surgical resection remains the treatment of choice for mature mediastinal teratoma, and the operation itself is sometimes complicated or life-threatening, especially when it ruptures into adjacent vital structures. We describe a rare case of unanticipatedly delayed complete resection of a symptomatic teratoma with simultaneous Haemophilus influenzae infection, followed by extended rupture into the pleural space, lung, and bronchus. The clinical presentation and the microbiological and radiologic features may lead to the impression of a lung abscess until it can be proven otherwise pathologically after an initial thoracic aspiration. Accordingly, surgical intervention through a minimal approach, such as video-assisted thoracoscopic surgery, might be considered a strategy after the initial extended rupture.

Resection of a ruptured mature cystic teratoma diagnosed two years after the onset of perforation

Perforated cystic teratomas are rare. Our patient was a 16-year-old female who presented with severe chest pain two years ago. A right-sided pleural effusion was accidentally detected by chest radiography performed at her school. Computed tomography revealed a high density area with multiple small, thickened, lobulated lesions and a low density area with pleural effusion adjacent to a thinned wall. Pathognomonic inhomogeneous computed tomography findings led to an accurate diagnosis of a mature teratoma that had ruptured long before presentation. Thoracoscopic resection was performed, and the final histological diagnosis was a mature teratoma with partial rupture.

Spontaneous rupture of a cystic mediastinal teratoma complicated by superior vena cava syndrome

Spontaneous rupture of cystic mediastinal teratomas is rare but may cause serious complications. Here we report an unusual case of a cystic teratoma, which ruptured into the mediastinal and pleural cavities resulting in superior vena cava syndrome, acute mediastinitis, and pleural effusion. Early diagnosis and prompt surgical treatment of ruptured mediastinal teratomas are essential to preventing life-threatening complications.