Open AccessPeri-operative anaesthesia challenges in large anterior mediastinal mass - A case report
Author(s) -
Rachna Wadhwa,
Varun Sharma,
Pallavi Ahluwalia,
Vishnu Datt
Publication year - 2021
Publication title -
indian journal of clinical anaesthesia
Language(s) - English
Resource type - Journals
eISSN - 2394-4781
pISSN - 2394-4994
DOI - 10.18231/j.ijca.2021.128
Subject(s) - medicine , airway , mediastinum , radiology , mediastinal shift , general anaesthesia , intubation , surgery , thorax (insect anatomy) , chest pain , anesthesia , radiography , lung , anatomy
Thymic mass is a rare tumor in the anterior mediastinum. They are usually of unknown etiology. About 50% of patients are diagnosed incidentally on chest radiographs. A 45 years, BMI-28, male patient presented to cardiac outpatient department with breathlessness and persistent cough for past three months. He also complained of generalized fatigue and nonspecific chest pain. On chest x-ray (PA view), there were diffuse opacities in middle and lower zone and no tracheal compression or deviation. Lateral neck X-ray also ruled out any airway compression. Computed tomography thorax revealed a huge mass occupying the prevascular compartment of mediastinum and insinuating the visceral compartment bilaterally with extension upto bilateral cardiophrenic and anterior costophrenic angles. CT-guided biopsy was consistent with thymolipoma which was surgically resected. Thymolipomas usually present with nonspecific symptoms. They pose a huge anaesthetic challenge during the peri-operative period in terms of difficult intubation, co-existing airway compression requiring reinforced tubes and fiberoptic guidance, the possibility of sudden airway collapse post-induction, risk of hypoxemia secondary to reduced functional residual capacity (FRC) and haemodynamic disturbances during and after removal of huge mass.