Tracheal obstruction in a child with a posterior mediastinal mass

Excerpt

Nearly complete tracheal obstruction is a potential catastrophe in a child. It is not commonly associated with a posterior mediastinal mass or a lymphoma. A five-year-old boy presented with chest pain and shortness of breath. Computed tomography (CT) scanning revealed tracheal obstruction above the carina. Rigid bronchoscopy, which was performed under an inhalational anesthetic, confirmed > 90% tracheal obstruction (Figure, left panel). After an uncuffed tube was carefully positioned beyond the tumor, magnetic resonance imaging (Figure, right panel) delineated a massive posterior mediastinal tumor that extended into the prevertebral space and compressed the posterior tracheal wall just above the carina. It almost completely occluded the lumen. CT-guided paraspinal tissue biopsy confirmed a B-cell Burkitt’s lymphoma, for which chemotherapy effectively resolved all symptoms, including the narrowed airway.

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