Superior mediastinal syndrome : a rare presenting feature of acute myeloid leukemia

Isolated Myeloid Sarcoma and Intracardiac Thrombus Resulting in Superior Mediastinal Syndrome

Superior mediastinal syndrome (SMS) is a relatively common emergency in the practice of Pediatric Oncology. It typically results from the compression of large airways and superior vena cava by a swiftly growing mass. T-lineage acute lymphoblastic leukemia or lymphoma, neuroblastoma, and germ cell tumor are the common etiologies of SMS in children. Occasionally, SMS can be an unexpected presentation of less common childhood cancers and a surprise for the diagnostic and treating teams. The present paper reports the diagnostic and therapeutic challenge of managing a 9-y-old boy with SMS resulting from mediastinal myeloid sarcoma. The presence of a sizeable intracardiac thrombus, in addition, contributed to the SMS. The initial pleural fluid cytology and image-guided fine-needle aspiration cytology of the mediastinal mass were nondiagnostic. A thoracotomy was subsequently performed to debulk the tumor for symptomatic relief and obtain tissue for diagnosis.

Aspergillus mediastinitis presenting as superior mediastinal syndrome in an immunocompetent child

We report a case of mediastinal mass caused by a fungal infection in an immunocompetent child. The patient presented with superior mediastinal syndrome along with a swelling in the chest wall. Cytology and culture demonstrated Aspergillus flavus. The child was treated with voriconazole, which resulted in clinical response.