scholarly journals Transient maintenance of tracheal patency upon the insertion of a flexible bronchoscope in a patient with an anterior mediastinal mass: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Takayuki Hasegawa ◽  
Shinju Obara ◽  
Rieko Oishi ◽  
Satsuki Shirota ◽  
Jun Honda ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Mediastinal Mass ◽  
Balloon Dilation ◽  
Maximum Flow ◽  
Anterior Mediastinal Mass ◽  
Positive Pressure ◽  
Anesthesia Induction ◽  
Flexible Bronchoscope ◽  
Case Presentation ◽  
Tracheal Collapse

Abstract Background Patients with an anterior mediastinal mass are at risk of perioperative respiratory collapse. Case presentation A 74-year-old woman with a large anterior mediastinal mass that led to partial tracheal collapse (shortest diameter, 1.3 mm) was scheduled for tracheobronchial balloon dilation and stent placement under general anesthesia. Although veno-venous extracorporeal membrane oxygenation (V-V ECMO) had been established, maximum flow was limited to 1.6 L/min, and general anesthesia induction was followed by hypoxia probably due to inadequate ventilation. A flexible bronchoscope was inserted through the tracheal lumen that was being compressed by the anterior mass; this not only increased tracheal patency but also enabled positive pressure ventilation and resulted in recovery from hypoxia. Scheduled procedures were successfully performed without complications. Conclusion We describe a case wherein tracheal patency was transiently maintained by inserting a flexible bronchoscope in a patient with an anterior mediastinal mass.

scholarly journals Thymic Cavernous Hemangioma Misdiagnosed as Thymoma: A Case Report and Review of the Literature

2021 ◽  
Author(s):  
Yi Chen ◽  
Liping Yan ◽  
Fangbiao zhang ◽  
Shaosong Tu ◽  
Zhijun Wu
Keyword(s):  
Cavernous Hemangioma ◽  
Renal Carcinoma ◽  
Mediastinal Mass ◽  
Clear Cell ◽  
Renal Clear Cell Carcinoma ◽  
Anterior Mediastinal Mass ◽  
Abdominal Ct ◽  
Case Presentation ◽  
Ct Evaluation ◽  
The Right

Abstract Introduction: Thymic cavernous hemangioma, a rare mediastinal tumor, is difficult to diagnose by imaging examinations. Case presentation: We treated a 63-year-old woman with thymic cavernous hemangioma. She was found to have an anterior mediastinal mass during a routine examination, and enhanced chest CT showed that it was approximately 3.5×2.4×2.1 cm in size. Enhanced abdominal CT indicated a 2.5cm space-occupying lesion in the right kidney. We considered it to be thymoma and renal carcinoma, so we resected it by using thoracoscope and laparoscope. The postoperative pathological reports showed that the mass was thymic cavernous hemangioma and renal clear cell carcinoma. Twenty months postsurgery, the patient was alive with no evidence of tumor recurrence.Conclusions: We report a rare case of thymic cavernous hemangioma misdiagnosed as thymoma. It is difficult to obtain pathological results by needle biopsy before surgery because the location of the anterior mediastinal mass is very challenging to reach. Therefore, a thorough CT evaluation before the operation can prevent inappropriate operations from being performed.

Abstract #576 Case Presentation: Graves Disease Association with Anterior Mediastinal Mass

2019 ◽  
Vol 25 ◽  
pp. 294
Author(s):  
Losty Torres Potter ◽  
Gustavo Meyreles-Chaljub ◽  
Natalia Weare-Regales ◽  
Pedro Troya ◽  
Madeline Candelario-Cosme
Keyword(s):  
Mediastinal Mass ◽  
Disease Association ◽  
Anterior Mediastinal Mass ◽  
Graves Disease ◽  
Case Presentation

scholarly journals General Anesthesia in Red-footed Tortoise (Chelonoides carbonaria) for Gastric Foreign Body Removal

2021 ◽  
Vol 49 ◽  
Author(s):  
Ellen Cristina Siepmann ◽  
Jéssica Fernanda Sinotti ◽  
Carolina Fucks de Souza ◽  
Hidemi Kelly Nishimura ◽  
Larissa Yurika Tanabe ◽  
...  
Keyword(s):  
Foreign Body ◽  
General Anesthesia ◽  
Muscle Relaxation ◽  
Positive Pressure ◽  
Induction Agent ◽  
Anesthesia Induction ◽  
Nociceptive Response ◽  
Foreign Body Removal ◽  
Normal Ranges ◽  
Long Duration

Background: The anatomical, physiological, and pharmacological characteristics of reptiles make anesthesia in chelonians particularly challenging. Specific literature regarding safe anesthetic protocols that provide immobilization, antinociception, amnesia, and unconsciousness are scarce. Thus, this paper aims to report the case of a red-footed tortoise submitted to long-duration general anesthesia to celiotomy for foreign body removal.  Case: An adult red-footed tortoise (Chelonoides carbonaria), 5.9 kg, was admitted due to hyporexia after ingesting a metallic fishhook. Serial radiographs confirmed the diagnosis and location of the foreign body in the stomach. The animal was premedicated with 0.03 mg/kg dexmedetomidine, 6 mg/kg ketamine, and 0.4 mg/kg butorphanol intramuscularly. After 90 min we inserted a 22G jugular catheter and proceeded to anesthesia induction with 5 mg/kg propofol. We intubated the animal with a 2.5 mm uncuffed endotracheal and started fluid therapy at a rate of 5 mL/kg/h. Surgical anesthesia was maintained with isoflurane in 0.21 oxygen, in a non-rebreathing circuit (baraka), under spontaneous breathing. Expired isoflurane was maintained between 3 and 4.5%. Due to reduced respiratory rate and hypercapnia, we opted for implementing manually-assisted positive pressure ventilation. Morphine (0.5 mg/kg) was administered at 10 and 87 min after the beginning of the surgery for further analgesia when the isoflurane requirement increased significantly. We did not detect any alterations in heart and body temperature. Surgical anesthesia lasted 6 h. During anesthesia recovery, voluntary head retraction and coordinated movement of the limbs occurred at 240 and 540 min after the extubation, respectively. In 2 days, the patient returned to voluntary feeding, being very active and responsive to stimulus. The post-surgical hematologic evaluation was unremarkable. Discussion: Pre-anesthetic medication aimed to promote sedation and preemptive analgesia. Due to its minimal cardiorespiratory depression, we chose the combination of ketamine, dexmedetomidine, and butorphanol. Dexmedetomidine reduced the ketamine dose and caused sufficient muscle relaxation and immobilization to perform the jugular catheter placement. Butorphanol is an agonist-antagonist opioid; that is why we decided to add it to the protocol for antinociception. However, due to signs of nociceptive response (increased isoflurane requirements and heart rate), and considering the evidence of a predominance of μ receptors in reptiles, we administered low-dose morphine twice during the procedure. Propofol was chosen as an induction agent at a dose sufficient to allow endotracheal intubation. Since reptilians often show apnea in the presence of 100% oxygen, we used a 0.21 oxygen fraction. Despite this, the patient showed respiratory depression. Due to right to left cardiac shunt, sudden changes in the direction of the blood can lead to very rapid changes in the serum concentrations of isoflurane, which leads to frequent oscillations in the anesthetic depth and consequently the need for vaporizer adjustments, which may justify the high expired isoflurane fraction during the procedure. Despite that, physiological parameters were maintained within normal ranges for the species, with slight variations during the surgical procedure. We conclude that the proposed anesthetic protocol is safe for long-duration anesthesia in chelonians, ensuring cardiovascular and respiratory stability. Thus, this report may help veterinarians to perform safe anesthesia in tortoises submitted to invasive surgical procedures.  Keywords: testudines, dexmedetomidine, ketamine, butorphanol. Descritores: testudines, dexmedetomidina, cetamina, butorfanol.

General Anesthesia in a Child with a Dynamic, Vascular Anterior Mediastinal Mass

1996 ◽  
Vol 84 (4) ◽  
pp. 976-979. ◽  
Author(s):  
Sheldon R. Furst ◽  
Patricia E. Burrows ◽  
Robert S. Holzman
Keyword(s):  
General Anesthesia ◽  
Mediastinal Mass ◽  
Anterior Mediastinal Mass

scholarly journals Re-expansion Pulmonary Edema after Drainage of Pleural Effusion in a Pediatric Patient with a Large Anterior Mediastinal Mass

2016 ◽  
Vol 1 (1) ◽  
Keyword(s):  
Pleural Effusion ◽  
Natural History ◽  
Respiratory Distress ◽  
Pulmonary Edema ◽  
Clinical Case ◽  
Mediastinal Mass ◽  
Operative Management ◽  
Anterior Mediastinal Mass ◽  
Newly Diagnosed ◽  
Case Presentation

Clinical case presentation of a 13 year old male with a newly diagnosed anterior mediastinal mass who developed rapid respiratory distress after drainage of a pleural effusion. We include a discussion of the incidence, natural history, and peri-operative management of children with re-expansion pulmonary edema.

scholarly journals Ultrasound-Guided Anterior Mediastinotomy: A Feasible Tool for Critical Lymphoma Patients

Healthcare ◽  
2021 ◽  
Vol 9 (6) ◽  
pp. 770
Author(s):  
Roberto Cascone ◽  
Annalisa Carlucci ◽  
Gaetana Messina ◽  
Antonio Noro ◽  
Mary Bove ◽  
...  
Keyword(s):  
General Anesthesia ◽  
Spontaneous Breathing ◽  
Mediastinal Mass ◽  
Diagnostic Yield ◽  
Correct Diagnosis ◽  
Rapid Onset ◽  
Spontaneous Respiration ◽  
Anterior Mediastinal Mass ◽  
Neoplastic Tissue ◽  
Surgical Biopsy

A significant part of all neoplasms growing in anterior mediastinum are lymphomas (25%). Achieving a correct diagnosis and a clear definition of a lymphoma’s subtype is crucial for beginning chemotherapy as soon as possible. However, most patients present a large mediastinal mass that compresses vessels and airway, with serious cardiorespiratory repercussions. Therefore, having multiple tools available to biopsy the lesion without worsening morbidity becomes fundamental. Patients enrolled in this study were unfit for a surgical biopsy in general anesthesia and the need to begin chemotherapy as fast as possible prompted us to avoid percutaneous fine needle aspiration to prevent diagnostic failures. Our observational study included 13 consecutive patients with radiological findings of anterior mediastinal mass. Ultrasonography was performed directly in the theatre to mark the lesion and to localize vessels and vascularized neoplastic tissue. Open biopsy was carried out in spontaneous breathing with a laryngeal mask and with short-acting medications for a rapid anesthesia, performing an anterior mediastinotomy. The mean operative time was 33.4 ± 6.2 min and spontaneous respiration was maintained throughout the procedure. No complications were reported. All patients were discharged in the first or second postoperative day after a chest X-ray (1.38 ± 0.5 days). The diagnostic yield of this approach was 100%. With the addition of ultrasonography right before the procedure and with spontaneous breathing, anterior mediastinotomy still represents a useful tool in critical patients that could hardly tolerate a general anesthesia. The diagnostic yield is high, and the low postoperative morbidity allows a rapid onset of chemotherapy.

scholarly journals Esophageal achalasia detected by vomiting during induction of general anesthesia: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kyoko Abe ◽  
Tetsu Kimura ◽  
Yukitoshi Niiyama
Keyword(s):  
General Anesthesia ◽  
Orthopedic Surgery ◽  
Heller Myotomy ◽  
Esophageal Achalasia ◽  
Anesthesia Induction ◽  
Dor Fundoplication ◽  
Case Presentation ◽  
History Of ◽  
Recovery From Anesthesia ◽  
Risk Of Aspiration

Abstract Background Esophageal achalasia is a rare disease with a high risk of aspiration during anesthesia induction. Here, we describe our experience involving a case of undiagnosed esophageal achalasia with profuse vomiting during anesthesia induction. Case presentation A 58-year-old woman was scheduled for orthopedic surgery under general anesthesia. She vomited a large amount of watery contents during anesthesia induction, and planned surgery was postponed. After recovery from anesthesia, she informed us that she usually had to drink a large amount of water to get food into her stomach and purged watery vomit every night before sleep. However, she attributed it to her constitutional problem, not to a specific disease. She was subsequently diagnosed with esophageal achalasia and underwent Heller myotomy with Dor fundoplication before her re-scheduled orthopedic surgery. Conclusions A detailed history of dysphagia and regurgitation should be taken in preoperative examinations to prevent unexpected aspiration due to undiagnosed achalasia.

scholarly journals Malignant giant solitary fibrous tumour of the mediastinum; masquerading Triton tumour

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Arshi Beg ◽  
Jeenal Parikh ◽  
Amit Janu ◽  
Rajiv Kumar Kaushal
Keyword(s):  
Mediastinal Mass ◽  
Spindle Cell ◽  
Solitary Fibrous Tumour ◽  
Anterior Mediastinal Mass ◽  
Mesenchymal Tumour ◽  
Case Presentation ◽  
Biopsy Confirmation ◽  
History Of ◽  
Resection Specimen ◽  
Spindle Cell Tumour

Abstract Background Malignant Solitary fibrous tumour (SFT) is an uncommon mesenchymal tumour with aggressive clinical behaviour as compared to its benign counterpart. There are only a handful of reports of extra-pleural malignant SFT arising from the mediastinum. Case presentation A 68-year-old male, presented with a history of cough and breathlessness for 2 weeks. Computed tomography (CT) scan revealed a large 11.6 × 11.3x18cm anterior mediastinal mass with extension to right hemithorax. The patient underwent excision of the mass after a biopsy confirmation of mesenchymal tumour. Histological examination of resection specimen revealed a spindle cell tumour with hypo and hypercellular areas, arranged in fascicular, focal storiform and hemangio-pericytomatous vasculature pattern. Moderate to marked nuclear atypia, frequent mitosis and areas of necrosis were noted. On immunohistochemistry (IHC), the tumour cells were positive for CD34, Bcl2, MIC2 (dot-like) and focally for S100 and Desmin. Although, the possibility of a malignant peripheral nerve sheath tumour with heterologous rhadomyosarcomatous differentiation (Triton tumour) was considered, however IHC for STAT6 confirmed it to be a malignant SFT. The patient developed recurrence within 1 year after surgery and despite multi-modality treatment (Re-excision, Chemotherapy and Radiotherapy) succumbed within 14 months from point of presentation. Conclusion Malignant SFT is a rare aggressive tumour that should be considered as a differential diagnosis in the mediastinum and a broad panel of IHC markers including STAT6 may be required to confirm the diagnosis.

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