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Wilkinson D, Yeung E, Samy S, Nakai C. Extracorporeal membrane oxygenation bridging for chemotherapy in obstructing mediastinal mass after cardiopulmonary arrest. J Cardiothorac Surg 2024; 19:382. [PMID: 38926736 PMCID: PMC11202388 DOI: 10.1186/s13019-024-02918-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Accepted: 06/15/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND In a sedated patient, airway compression by a large mediastinal mass can cause acute fatal cardiopulmonary arrest. Extracorporeal membrane oxygenation (ECMO) has been investigated to protect the airway and provided cardiopulmonary stability. The use of ECMO in the management of mediastinal masses was reported, however, the management complicated by cardiopulmonary arrest is poorly documented. CASE PRESENTATION 32-year-old female presented with acute onset of left arm swelling and subacute onset of dry cough. Further investigation showed a deep venous thrombosis in left upper extremity as well as a large mediastinal mass. She underwent mediastinoscopy with biopsy of the mass which was complicated by cardiopulmonary arrest secondary to airway obstruction by the mediastinal mass. Venoarterial ECMO was initiated, while concurrently treating with a chemotherapy. The mediastinal mass responded to the chemotherapy and reduced in size during 2 days of ECMO support. She was extubated successfully and decannulated after 2 days of ECMO and discharged later. CONCLUSIONS Extracorporeal membrane oxygenation can serve as a viable strategy to facilitate cardiopulmonary support while concurrently treating the tumor with chemotherapy, ultimately allowing for the recovery of cardiopulmonary function, and achieving satisfactory outcomes.
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Affiliation(s)
- Daniel Wilkinson
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Enoch Yeung
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Sanjay Samy
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA
| | - Chikashi Nakai
- Department of Cardiothoracic Surgery, Albany Medical Center, Albany, NY, USA.
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Leivaditis V, Pavlakou A, Grapatsas K, Mulita F, Koletsis E, Papatriantafyllou A, Galanis M, Katsakiori PF, Skevis K, Nikolaidis E, Dahm M, Tasios K, Tchabashvili L, Ehle B, Baltayiannis N. Challenges and pitfalls in the perioperative management of mediastinal mass syndrome: an up-to-date review. KARDIOCHIRURGIA I TORAKOCHIRURGIA POLSKA = POLISH JOURNAL OF CARDIO-THORACIC SURGERY 2024; 21:47-54. [PMID: 38693982 PMCID: PMC11059013 DOI: 10.5114/kitp.2024.138581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 12/03/2023] [Indexed: 05/03/2024]
Abstract
The perioperative management of patients undergoing mediastinal mass operations presents a persistent challenge across multiple clinical specialties. General anesthesia administration further increases the risk of perioperative cardiorespiratory decompensation. The interdisciplinary team plays a crucial role in ensuring a safe perioperative period. However, due to the rarity and variability of mediastinal mass syndromes, specific management protocols are lacking. This review aims to outline the multitude of challenges and pitfalls encountered during perioperative management in patients with the mediastinal mass syndrome. We describe diagnostic evaluation, preoperative optimization, intraoperative considerations, and postoperative care strategies, emphasizing the paramount significance of a multidisciplinary approach and personalized treatment plans. Preoperative multidisciplinary discussions, meticulous anesthetic management, and well-established protocols for emergency situations are pivotal to ensuring patient safety. Healthcare providers involved in the care of patients with mediastinal mass syndrome must grasp these challenges and pitfalls, enabling them to deliver safe and effective perioperative management.
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Affiliation(s)
- Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Afroditi Pavlakou
- Department of Anesthesiology, Metaxa Cancer Hospital, Piraeus, Greece
| | - Konstantinos Grapatsas
- Department of Thoracic Surgery and Thoracic Endoscopy, University Medicine Essen – Ruhrland Clinic, Essen, Germany
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, University Hospital of Patras, Patras, Greece
| | | | - Michail Galanis
- Department of Thoracic Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | | | - Manfred Dahm
- Department of Cardiothoracic and Vascular Surgery, WestpfalzKlinikum, Kaiserslautern, Germany
| | - Konstantinos Tasios
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Levan Tchabashvili
- Department of Surgery, General University Hospital of Patras, Patras, Greece
| | - Benjamin Ehle
- Department of Thoracic Surgery, Asklepios Lung Clinic Munich-Gauting, Gauting, Germany
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Zhou X, Wang L, Zhang Y, Wu Q, Cao Y. The Heimlich maneuver and chest compression relieve mask ventilation difficulties caused by asymptomatic laryngeal mass: A case report and review of literature. Medicine (Baltimore) 2023; 102:e36362. [PMID: 38050299 PMCID: PMC10695483 DOI: 10.1097/md.0000000000036362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/08/2023] [Indexed: 12/06/2023] Open
Abstract
RATIONALE Some laryngeal masses are typically asymptomatic and easily ignored. However, they can be rare causes of unanticipated difficult airway, leading to critical situations such as "cannot ventilate" or "cannot ventilate and cannot intubate" during anesthesia induction. Inappropriate airway management in such scenarios can have catastrophic consequences for an anesthetized patient. Here we report a case of sudden, unanticipated difficult mask ventilation caused by an asymptomatic supraglottic mass during sedative induction, which was quickly and effectively relieved by the Heimlich maneuver and chest compression. PATIENT CONCERNS We report a rare case of airway crisis occurred during sedative induction in a 63-year-old patient scheduled for a routine flexible bronchoscopy, and no evidence of respiratory difficulty or signs of obstruction was found in preoperative evaluation. DIAGNOSES A detailed examination of laryngopharyngeal structure under bronchoscopy revealed a supraglottic soft-tissue mass with a size of 1.6 × 0.8 cm covering the membranous part of the glottic area, which was the true cause of difficult mask ventilation in this patient during sedative induction. INTERVENTIONS As the unanticipated difficult mask ventilation occurred, 2-handed mask ventilation was initiated immediately for 9 attempts but failed. Fortunately, the airway crisis was successfully relieved with 2 Heimlich attempts and 3 chest compressions, and no need for a laryngeal mask airway. OUTCOMES Once the airway crisis was relieved and the supraglottic mass was confirmed, the patient underwent a second sedative anesthesia and a successful laryngeal mask airway-assisted bronchoscopy, with no post-bronchoscopy adverse events. LESSONS Asymptomatic supraglottic masses can cause valve-like upper airway obstruction and lead to unanticipated difficult mask ventilation. The Heimlich maneuver and chest compression may be effective in such critical situations and can serve as an emergency intervention.
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Affiliation(s)
- Xuefei Zhou
- Department of Anesthesiology, Beilun District People’s Hospital of Ningbo, Ningbo, China
| | - Longfei Wang
- Department of Anesthesiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China
| | - Yonghua Zhang
- Department of Respiratory, Beilun District People’s Hospital of Ningbo, Ningbo, China
| | - Qiuyue Wu
- Department of Anesthesiology, Beilun District People’s Hospital of Ningbo, Ningbo, China
| | - Yunfei Cao
- Department of Anesthesiology, Beilun District People’s Hospital of Ningbo, Ningbo, China
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Kandler N, Schilling T, Fakundiny B, Walles T, Lücke E. [Risky confirmation of a diagnosis: case series of three female patients with mediastinal mass syndrome]. CHIRURGIE (HEIDELBERG, GERMANY) 2023:10.1007/s00104-023-01862-5. [PMID: 37191682 DOI: 10.1007/s00104-023-01862-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/08/2023] [Indexed: 05/17/2023]
Abstract
Mediastinal mass syndrome (MMS) is a life-threatening complication of anesthesia for which prevention and treatment are a complication-prone interdisciplinary task. Clinical symptoms vary from asymptomatic patients up to life-threatening cardiorespiratory impairments, depending on the extent and size of a mediastinal tumor as well as the involvement of corresponding anatomical structures. Especially in the context of sedation or general anesthesia, there is a considerable risk of acute cardiopulmonary or respiratory decompensation related to tumor-induced compression of central blood vessels or even the large airways, which may result in severe complications, including death. In this case series three female patients are presented, who were each referred to this hospital with a mediastinal tumor for interventional or surgical confirmation of the diagnosis. Based on the case histories, characteristic complications are demonstrated and strategies to avoid possible adverse events of MMS are discussed. The specific anesthesiological requirements for MMS, the safety aspects of the choice of surgical and anesthesia procedures, circulatory and airway management for the required single-lung ventilation, and various aspects of the selection of the anesthetic agents are discussed in this case series.
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Affiliation(s)
- Nadine Kandler
- Klinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Thomas Schilling
- Klinik für Anaesthesiologie und Intensivtherapie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland.
| | - Bastian Fakundiny
- Klinik für Herz- und Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Thorsten Walles
- Klinik für Herz- und Thoraxchirurgie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
| | - Eva Lücke
- Klinik für Pneumologie, Otto-von-Guericke-Universität Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Deutschland
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Yu M, Li K, Liu D, Tan Y. Safety and Efficacy of Endoscopic Treatment of Solitary Gastric Neurofibroma. Int J Gen Med 2022; 15:279-289. [PMID: 35023965 PMCID: PMC8747736 DOI: 10.2147/ijgm.s339564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 12/16/2021] [Indexed: 12/02/2022] Open
Abstract
Purpose The studies on solitary gastric neurofibroma (GN) consist of only individual case reports, with little data and relevant information. We aimed to summarize the clinical features, endoscopic features, imaging findings, and pathological features and study the safety and efficacy of endoscopic treatment of solitary GN. Patients and Methods We retrospectively collected and analyzed clinical data of patients who underwent endoscopic treatment in Department of Gastroenterology of a well-known tertiary hospital from August 2007 to September 2019 and were accurately diagnosed as having solitary GN. Results A total of 788 patients with gastric submucosal tumors underwent endoscopic treatment, among whom 11 patients were found to have solitary GNs. The incidence of solitary GNs was 1.4%. All 11 patients were treated with endoscopy. Five patients underwent endoscopic full-thickness resection (EFTR) and six patients underwent endoscopic submucosal excavation (ESE). The en bloc resection rate of the 11 lesions was 100.0%. The median endoscopic operation time was 80 minutes. Average length of hospital stay was 6.4 ± 1.6 days. The median follow-up time was 29 months. No recurrence, distant metastasis, or disease-related death occurred during the follow-up. Conclusion EFTR and ESE can serve as feasible, safe, and effective treatments for solitary GN.
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Affiliation(s)
- Meihong Yu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, People's Republic of China
| | - Kaixuan Li
- Department of Urology, Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China
| | - Deliang Liu
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, People's Republic of China
| | - Yuyong Tan
- Department of Gastroenterology, The Second Xiangya Hospital of Central South University, Changsha, Hunan, People's Republic of China.,Research Center of Digestive Disease, Central South University, Changsha, Hunan, People's Republic of China
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Zhang Z, Wang X, Zhou Z, Wang J, Jiang G. Surgical treatment for esophageal neurofibroma: report of two cases and review of literature. BMC Surg 2021; 21:88. [PMID: 33596862 PMCID: PMC7888069 DOI: 10.1186/s12893-020-00950-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/08/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neurofibroma of the esophagus, originated from the nerve sheath cells and fibroblasts of the esophageal submucosal plexus or the intestinal intermuscular plexus, is a very rare mesenchymal tumor. Most of the cases are treated by surgical methods. Due to the technical complexity of video-assisted thoracoscopic surgery (VATS), there are few reports in the literature of VATS for esophageal neurofibroma in recent years. CASE PRESENTATION We report on two rare cases of esophageal neurofibroma, one of which is a 52-year-old male patient diagnosed with a 4.6 × 5.7 cm upper esophageal submucosal tumor in physical examination. He was admitted to our hospital and the tumor was enucleated by VATS combined with intraoperative endoscopy. There were no complications after operation, and the patients was discharged on the 16th postoperative day. The other patient was a 76-year-old man, with the main clinical manifestation of dysphagia for over 1 year, diagnosed with an 8.0 × 6.0 × 8.0 cm giant subepithelial mass in the lower esophagus. As the intraoperative exploration revealed the tumor connected tightly with the wall of the esophagus, this patient treated by transthoracic partial esophagectomy. The patient was discharged on the 14th postoperative day, and no signs of post-operative complication during the 53-month follow-up. The diagnosis of esophageal neurofibroma was based on these patients' postoperative pathological examination. In the latest follow-up, these two patients had no evidence of long-term postoperative complication and recurrence. CONCLUSION This is the first reported case of 5 cm in diameter esophageal neurofibroma treated by VATS. This technique can be a commendable treatment option for esophageal neurofibroma, and the tumor diameter is not an absolute contraindication for thoracoscopy. To reduce the unnecessary damage, surgical method for complete tumor resection needs to be determined according to preoperative imaging and intraoperative conditions, partial esophagectomy can be performed via thoracotomy or thoracoscopy for removing neurofibroma when necessary.
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Affiliation(s)
- Zhedong Zhang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Xun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China.
| | - Zuli Zhou
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, 100044, China
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Song P, Josten NJ, Cheng AM. Posterior Mediastinal Mass Resection Requiring Venoarterial and Venovenous Extracorporeal Membrane Oxygenation Support. J Cardiothorac Vasc Anesth 2021; 36:1127-1131. [PMID: 33551239 DOI: 10.1053/j.jvca.2021.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Pingping Song
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA.
| | - Nicholas J Josten
- Department of Anesthesiology and Pain Medicine, University of Washington Medical Center, Seattle, WA
| | - Aaron M Cheng
- Department of Surgery, University of Washington Medical Center, Seattle, WA
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Ramanathan K, Leow L, Mithiran H. ECMO and adult mediastinal masses. Indian J Thorac Cardiovasc Surg 2021; 37:338-343. [PMID: 33967453 DOI: 10.1007/s12055-020-01077-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 12/19/2022] Open
Abstract
The role of extracorporeal membrane oxygenation (ECMO) is expanding as surgeons look at its utility beyond rescue treatment and have started adopting it for high-risk procedures to provide temporary airway and hemodynamic stabilization. ECMO needs to be deliberated in all patients with mediastinal masses who have compromised airways as well as in those with compression of heart and great vessels. There is a dearth of literature highlighting the definitive role of ECMO in patients with mediastinal masses. This article reviews the available adult literature and highlights the possible situations where the use of ECMO would be supportive in the management of patients with mediastinal masses.
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Affiliation(s)
- Kollengode Ramanathan
- Cardiothoracic Intensive Care Unit, National University Heart Centre, Singapore, Singapore.,Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore
| | - Lowell Leow
- Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore.,Division of Thoracic Surgery, National University Heart Centre, Kent Ridge Rd, Singapore, Singapore
| | - Harish Mithiran
- Department of Cardiothoracic and Vascular Surgery, National University Heart Centre, 1E Kent Ridge Road, NUHS Tower Block, Level 9, Singapore, 119228 Singapore.,Division of Thoracic Surgery, National University Heart Centre, Kent Ridge Rd, Singapore, Singapore
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Samat SH, Onyemkpa C, Torabi M, Oyasiji T. Understanding esophageal neurofibroma: A case series and systematic review. Int J Surg Case Rep 2020; 76:450-457. [PMID: 33207410 PMCID: PMC7586048 DOI: 10.1016/j.ijscr.2020.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Esophageal neurofibroma is a rare benign esophageal neoplasm. With very few cases documented in the literature, not much is known about the demographics and clinicopathologic features of this tumor. This study was aimed at presenting a case report of an esophageal neurofibroma, and to conduct a systematic review of published cases. METHOD This review was performed according to the PRISMA guidelines. Literature search was conducted through PubMed, SCOPUS, and Cochrane Databases from inception until May 2020 for all histologically confirmed cases of esophageal neurofibroma. RESULTS 28 cases, including the newly reported case, were included in the review. The mean age at diagnosis was 53.3 years ±12.1. 53.6% were male. Dysphagia was the most common presenting symptom (53.6%). Most of the reported cases involved the upper esophagus (39.3%). The most utilized diagnostic test was esophagogastroduodenoscopy (57.1%). The mean tumor size was 6.1 cm ± 5.1. Preoperative biopsy was done for 9 cases, out of which seven were negative or inconclusive. In 17 cases (60.7%), immunohistochemical (IHC) staining of the resected tumor was not performed. S100 was the most utilized IHC stain. Enucleation (39.3%) was the most common treatment, followed by esophagectomy (28.6%). CONCLUSION Esophageal neurofibroma should be considered in the setting of dysphagia caused by a subepithelial tumor. Accurate preoperative histologic diagnosis by using a well-defined biopsy algorithm, in conjunction with IHC analysis, will favor less aggressive surgical treatment and surveillance of asymptomatic lesions. Minimally invasive surgical treatment is feasible and should be considered when the expertise is available.
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Affiliation(s)
- Sajjaad H Samat
- Department of Surgery, Michigan State University, Lansing, MI, USA
| | | | - Mohammad Torabi
- Department of Surgery, Michigan State University, Lansing, MI, USA
| | - Tolutope Oyasiji
- Department of Surgery, Michigan State University, Lansing, MI, USA; Department of Surgical Oncology, Barbara Ann Karmanos Cancer Institute at McLaren Flint, Wayne State University, 4100 Beecher Road, Flint, MI, 48532, USA.
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