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Case report: giant cardiac malignancy in a nine-year-old female. Can J Anaesth 2012 Nov;59(11):1048-51 PMID: 22936572

Pubmed ID

22936572

Abstract

PURPOSE: To describe the management of a giant cardiac malignancy initially diagnosed as an anterior mediastinal mass.

CLINICAL FEATURES: A nine-year-old female with right facial swelling and chronic cough was diagnosed with a large right mediastinal mass. Intermittent ventricular and supraventricular arrhythmias were noted on admission electrocardiograms. Empiric corticosteroid and radiation therapy did not reduce the size of the tumour, and initial tissue biopsies were non-diagnostic. Due to worsening tamponade physiology and persistent arrhythmias, the patient was scheduled for tumour debulking with potential resection. Prior to surgery, a multidisciplinary team was assembled to delineate team member responsibilities and treatment algorithms. The procedure was performed under general anesthesia with spontaneous ventilation preserved during endotracheal intubation and invasive line placement. The team was prepared to provide extracorporeal mechanical support if needed. The child required inotropic and vasoactive medications after transitioning to positive pressure ventilation, but her hemodynamics improved with sternotomy. The lesion was identified as a malignant cardiac clear-cell tumour that was unresectable. Her sternum was left open, as attempted closure led to the re-creation of tamponade physiology. She underwent delayed sternal closure days later. After months of chemotherapy that resulted in significant tumour involution, she underwent successful surgical resection.

CONCLUSION: Giant primary cardiac tumours may present similarly to large anterior mediastinal masses. The care of patients with these lesions requires an understanding of the risks associated with mediastinal masses as well as those unique to cardiac tumours. A multidisciplinary approach is critical to providing safe and effective care throughout this process.

Author List

Scott JP, Troshynski TJ, Clarke WR, Woods RK, Lal DR, Berens RJ, Tower RL

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
Dave Lal MD, MPH Professor in the Surgery department at Medical College of Wisconsin
John P. Scott MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Richard L. Tower MD Associate Professor in the Pediatrics department at Medical College of Wisconsin
Todd J. Troshynski MD Associate Professor in the Anesthesiology department at Medical College of Wisconsin
Ronald K. Woods MD Professor in the Surgery department at Medical College of Wisconsin




Scopus

2-s2.0-84871224718

MESH terms used to index this publication - Major topics in bold

Adenocarcinoma, Clear Cell
Anesthesia, General
Arrhythmias, Cardiac
Biopsy
Cardiac Tamponade
Child
Combined Modality Therapy
Echocardiography
Electrocardiography
Female
Heart Neoplasms
Humans
Mediastinal Neoplasms
Monitoring, Physiologic
Positive-Pressure Respiration
jenkins-FCD Prod-256 97250b83e4554f37bec91ca291f44ff4aedcc508