The May 2016 Journal of Pediatric Surgery Case Reports includes a case report co-authored by four physicians including Jeffrey P. Morray, M.D., a pediatric anesthesiologist with Valley Anesthesiology Consultants in Phoenix, AZ. The report presents the case of an 11-year-old girl who had been experiencing facial swelling and intermittent right arm swelling for several weeks. She had been seen by numerous providers who presumed that these symptoms were caused by allergies and who treated them initially with antihistamines and then steroids. These medications alleviated her swelling only briefly. When her symptoms returned, she was treated with a second round of steroids and an antibiotic. After being referred to an otolaryngologist, a dermatologist and an allergist, eventually she was admitted to the hospital. Her workup upon admission included an echocardiogram that revealed a very large tumor that had formed in the area of the chest between her lungs. The tumor was compressing her superior vena cava, the second-largest vein in the human body. These findings were confirmed by CT (Computed Tomography) scan, a diagnostic imaging test that creates detailed images of internal organs, bones, soft tissue and blood vessels.
Numerous enlarged lymph nodes in the patient’s neck and lung region suggested lymphoma. Because swelling made it difficult to examine the lymph nodes in the neck, the surgical team determined that a surgical biopsy under a general anesthetic would be the best course of action.
The case report presents in detail how doctors used a sternal elevator system for emergency elevation of the patient’s breastbone as a bridge to ECMO (a treatment that uses a pump to circulate blood through an artificial lung back into the bloodstream of a very ill child) until doctors were able to treat the mass definitively and stabilize the patient. The surgery required a complex anesthesia strategy to minimize the risk of airway collapse.
To learn more, read the full case report.