Neurogenic tumour of the posterior mediastinum: double the complications

Neurogenic tumour of the posterior mediastinum: double the complications

Published: 30 Apr 2018

© Anaesthesia Cases / 2018-0042 / ISSN 2396-8397

Authors

Dr Hani Abdalla [1]
Dr Andrea Bille [2]
Dr Cheng Ong [3]
  • [1] Trust Doctor, Anaesthesia, Guy's and St Thomas's NHS Trust, London, United Kingdom
  • [2] Consultant, Thoracic Surgery , Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
  • [3] Consultant, Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom

Summary

Neurogenic tumours are the most common posterior mediastinal masses. They are usually benign, slow-growing and can be large enough to cause compression symptoms on surrounding structures, including the airway, heart, great vessels, nerves and ganglia. Anaesthetic management of these patients requires anatomical knowledge of adjacent structures, and an expectant approach to potential complications such as haemorrhage.

We present a case of a large, non-functional neurogenic tumour of the posterior mediastinum with cervical extension that presented with symptoms of sympathetic ganglia blockade. This was resected by cervical and thoracic approaches. Our case highlights intra-operative management, and the early detection of a subclavian artery stenosis by vigilant monitoring. We also describe our choice for postoperative analgesia and the potential side-effects mimicking complications of sympathetic trunk resection.

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