Giant mediastinal mass
Danilo Coco1,&, Silvana Leanza2
1Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy, 2Department of General Surgery, Carlo Urbani Hospital, Jesi, Ancona, Italy
Danilo Coco, Department of General Surgery, Ospedali Riuniti Marche Nord, Pesaro, Italy
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A 43-year-old Caucasian female presented to the ED with significant dyspnea, thoracic pain and fever. She presented a negative medical history and no therapy. During the physical examination, the patient was uncomfortable. Her vital signs were: blood pressure, 100/90 mmHg; respiratory rate, 50 breaths/minute; heart rate, 130 beats/minute; and temperature superior of 38°C. Oxygen saturation was 80% on room air and 90% with the aid of oxygen. The abdominal examination was unremarkable. Laboratory evaluation revealed high leukocytosis with a white blood cell (WBC) count of 15 per mm3. Arterial Blood Gases (ABG) demonstrated respiratory acidosis: PO2 80, PCO2 60, HCO3 30 mEq. Thoracic X-ray revealed a massive plural effusion. Computed tomography demonstrated a giant mediastinal mass surrounding pulmonary artery, aorta and pericardia pleura associated with massive pleural effusion. The patients immediately started intravenous (IV) fluids of 2l in 6 hours, Foley and jugular catheter vein cannulation to support main arterial pressure and urine output. The patient was transferred to surgical services where a 28 Fr thoracic drainage was inserted. Post-drainage Thoracic Scan (TC) demonstrated only the giant mediastinal mass. FNA CT scan guided was performed. Hysto-patological findings were mediastinal lymphoma B-Cells. The patient was discharged three day after.
Figure 1: A) thoracic Computed Tomography (CT) scan demonstrated a giant mediastinal mass associated with massive left pleural effusion; B) post-28 Fr thoracic drainage demonstrated the extention of giant mediastinal mass; C) FNA thoracic TC scan biopsy