Cases reported "Mediastinal Diseases"

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1/28. life-threatening airway obstruction caused by a retropharyngeal haematoma.

    We present the case of a 68-year-old woman who had a large cervicomediastinal haematoma that caused life-threatening airway obstruction. Retropharyngeal haematoma may occur in any age group and following a variety of causes. Retropharyngeal haematomas must be considered as a cause of airway obstruction following common injuries such as blunt cervical trauma or internal jugular vein cannulation. A high index of suspicion and early lateral neck X-ray is essential for safe management of this rare but potentially life-threatening injury.
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ranking = 1
keywords = airway obstruction, obstruction, airway
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2/28. Spontaneous rupture of the common carotid artery presenting as a widened mediastinum.

    Spontaneous rupture of the common carotid artery is an extremely rare disorder. Presentation in an elderly gentleman as a widened mediastinum with cardiac compromise has not been previously reported. Emergency surgical exploration to decompress the airway revealed a 5-mm tear just proximal to the left common carotid artery bifurcation and a large para-oesophageal haematoma. The case is reviewed and the possible causes discussed.
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ranking = 0.0066445846693401
keywords = airway
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3/28. Graves' disease and recurrent ectopic thyroid tissue.

    Ectopic thyroid tissue is the result of abnormal migration of the gland as it travels from the floor of the primitive foregut to its destined pretracheal position. The prevalence of ectopic thyroid tissue ranges between 7%-10%. patients with ectopic thyroid tissue are usually euthyroid, but can present with signs and symptoms of upper aerodigestive tract obstruction. We report a case in which ectopic mediastinal thyroid tissue was removed surgically because of substernal chest pain. It recurred 9 years later when the patient developed Graves' disease. We propose that the recurrence of the ectopic thyroid tissue was due to the influence of thyroid stimulating immunoglobulins (TSI).
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ranking = 0.0091017101598787
keywords = obstruction
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4/28. Postpneumonectomy syndrome after left pneumonectomy.

    Postpneumonectomy syndrome, a late complication of pneumonectomy, is secondary to shift of the mediastinum and remaining lung toward the pneumonectomy side, leading to tracheobronchial compression between the vertebral body and the aorta or pulmonary artery. Obstructive airway symptoms are usually due to tracheobronchial tree compression, however, secondary airway malacia may develop. We report herein a case of postpneumonectomy syndrome with secondary bronchomalacia after left pneumonectomy in a patient with normal mediastinal vascular anatomy.
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ranking = 0.01328916933868
keywords = airway
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5/28. Mediastinal tuberculosis in a 10-month-old child.

    We report a rare case of mediastinal tuberculosis in a child who presented as a possible inhaled foreign body. A 10-month-old girl was admitted with a five-month history of cough, wheeze and problematic feeding, thought initially to be due to asthma. A clinical deterioration and subsequent x-rays suggested an inhaled foreign body. However, at direct laryngotracheobronchoscopy no foreign body was found and subsequent investigations revealed a subcarinal mediastinal mass. She underwent a thoracotomy and excision of the mass, the histological analysis of which revealed it to be of tuberculous origin. When a patient presents with symptoms of upper airway obstruction which are highly suggestive of a foreign body, other causes such as mediastinal tuberculosis must be borne in mind when no foreign body can be found. Although rare, cases of tuberculosis are apparently increasing and the otolaryngologist must be aware of its various manifestations and submit specimens for appropriate analysis. We also briefly review mediastinal lymphadenopathy due to tuberculosis.
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ranking = 0.16666666666667
keywords = airway obstruction, obstruction, airway
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6/28. Percutaneous pulmonary artery and vein stenting: a novel treatment for mediastinal fibrosis.

    Mediastinal fibrosis is a rare consequence of infection with the fungus histoplasma capsulatum that can lead to occlusion of large pulmonary arteries and veins and mainstem bronchi. Medical and surgical treatments for this disorder have been ineffective. We describe successful treatment for central pulmonary arterial and venous obstruction due to mediastinal fibrosis in four patients using percutaneously placed intravascular stents. patients were severely limited, world health organization functional class III or IV. At the time of right and left heart catheterization, stents were placed in pulmonary arteries (n = 1), veins (n = 2), or both (n = 1) to relieve vascular obstruction resulting from mediastinal fibrosis. Immediate hemodynamic and clinical improvement was observed in all patients. Three of the four patients have had sustained improvement in exercise tolerance, from 3.5 mo to 4.5 yr after stent placement. The only complication was a self-limited pulmonary hemorrhage in one patient. Our initial experience suggests that percutaneous stent placement to relieve central pulmonary arterial or venous obstruction due to mediastinal fibrosis is an effective new treatment modality.
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ranking = 0.027305130479636
keywords = obstruction
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7/28. Mediastinal fibrosis.

    Mediastinal fibrosis is the least common, but the most severe, late complication of histoplasmosis. It should be differentiated from the many other less-severe mediastinal complications of histoplasmosis, and from other causes of mediastinal fibrosis. Posthistoplasmosis mediastinal fibrosis is characterized by invasive, calcified fibrosis centered on lymph nodes, which, by definition, occludes major vessels or airways.
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ranking = 0.0066445846693401
keywords = airway
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8/28. Anaesthetic consequences for a child with complex multilevel airway obstruction -- recommendations for avoiding life-threatening sequelae.

    A boy with a suspected lymphoid malignancy presented with gross head and neck lymphadenopathy, a middle mediastinal mass, and rapidly worsening airway obstruction. General anaesthesia was required for definitive histopathological diagnosis. The combination of nasopharyngeal obstruction, malignant infiltration of the tonsils and pharynx, laryngeal displacement, and potential tracheal compression put this patient at extreme risk for perioperative airway complications. risk assessment, and the impact of anaesthesia on pharyngeal neuromechanical function and mediastinal masses are discussed. Caution with volatile anaesthetic agents is recommended in the patient with an inherently unstable pharynx and/or trachea, in whom airway patency relies on a spontaneously breathing technique and intact airway reflexes.
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ranking = 0.86236879750123
keywords = airway obstruction, obstruction, airway
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9/28. Mediastinal bronchogenic cyst. A cause of upper airway obstruction.

    Although bronchogenic cysts may involve the mediastinum, they have rarely been responsible for significant upper airway obstruction. We describe a young man who had a rapidly expanding cervical mass due to the migration of a mediastinal bronchogenic cyst. Flow-volume loops confirmed the presence of a variable intrathoracic obstruction. The patient rapidly developed respiratory failure requiring urgent intubation and surgical resection.
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ranking = 0.84243504349321
keywords = airway obstruction, obstruction, airway
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10/28. Anesthetic considerations in steroid-induced mediastinal lipomatosis.

    Mediastinal lipomatosis (ML) is a benign condition characterized by circumscribed overgrowth of adipose tissue producing mediastinal widening that can cause errors in diagnosis on chest roentgenogram. We describe a case of steroid-induced ML leading to difficulty in central venous catheterization during surgery and its other implications for anesthesiologists. Because many patients receive long-term steroid administration and present for surgical intervention, it is essential that they undergo detailed preoperative evaluation to exclude Cushing's syndrome and various pressure effects. IMPLICATIONS: This case report highlights problems during right internal jugular vein cannulation resulting from high back pressure and flow from superior vena cava obstruction in steroid-induced mediastinal lipomatosis. Other anesthetic considerations in mediastinal lipomatosis are also discussed.
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ranking = 0.0091017101598787
keywords = obstruction
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