Abstract | OBJECTIVE: To describe the clinical course and treatment of a large mediastinal mass with unusual presentation and critical lower airway compression in an adolescent. DESIGN: Case report. SETTING: Pediatric intensive care unit in a tertiary care, academic children's hospital. PATIENTS: A previously well 15-yr-old boy presented to an outside physician with a 2-mo history of widening of his fingernail beds, progressing within a month of admission to fatigue, weight loss, progressive cough, and dyspnea on exertion. One week before admission, he developed facial swelling, headache, and large neck, chest, and abdomen veins. At the time of admission, he was hypoxic and had a large mediastinal mass with severe lower airway compromise, right-sided atelectasis and pleural effusion, as well as significant right atrial compression on chest computed tomography. INTERVENTION: RESULTS: CONCLUSIONS: Mediastinal mass with true critical airway and vascular compromise is often discussed but infrequently seen in the pediatric intensive care unit. This case shows not only unusual associated signs of lymphoma (clubbing and caput medusae) but more importantly the rapid identification and thoughtful management of the patient's respiratory compromise. This case serves to remind the pediatric intensivist of alternative ways to provide analgesia safely in such patients for lifesaving as well as diagnostic invasive procedures.
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Authors | Marc A Yester, Samuel J Ajizian |
Journal | Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
(Pediatr Crit Care Med)
Vol. 11
Issue 4
Pg. e44-7
(Jul 2010)
ISSN: 1529-7535 [Print] United States |
PMID | 20407398
(Publication Type: Case Reports, Journal Article)
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Topics |
- Adolescent
- Airway Obstruction
(etiology)
- Biopsy
- Critical Care
- Humans
- Intensive Care Units, Pediatric
- Lymphoma, Non-Hodgkin
(complications, diagnosis)
- Male
- Mediastinal Neoplasms
(complications, diagnosis)
- Osteoarthropathy, Secondary Hypertrophic
(etiology)
- Pleural Effusion
(etiology)
- Radiography, Thoracic
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