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Anterior mediastinal tumour identified by intraoperative transesophageal echocardiography

From the Department of Anesthesiology, Chang Gung Memorial Hospital, 5 Fu-Shin St, Kweishan, Taoyuan, Taipei, Taiwan, R.O.C.

Address correspondence to: Chun-Ming Lin MD; Phone: 886-3-3281200, ext.2389; Fax: 886-3-3281200, ext.2793; E-mail: sam2498{at}adm.cgmh.com.tw

Purpose: To report a child with anterior mediastinal tumour misdiagnosed as pericardial effusion who had been sent to the operating theatre for drainage. After induction of general anesthesia she developed cardio-respiratory collapse. The diagnosis was made with the aid of transesophageal echocardiography (TEE).

Clinical features: A 14-yr-old girl suffered from cough and intermittent fever for one month before admission. Four days before admission, she became orthopneic and was admitted to the intensive care unit. Precordial echocardiography showed an anterior and posterior echolucent space between the pericardium and epicardium that was thought to be a pericardial effusion. She was sent to the operating room for emergency drainage.

After induction of general anesthesia, breath sounds were not heard on the left side of the chest. The patient developed increasing hypoxemia and hypotension despite cardiocentesis. A TEE determined that an anterior mediastinal mass was the cause of her hypoxemia and hypotension. The tumour was debulked and the patient made an uneventful postoperative recovery.

Conclusion: In this case, the correct diagnosis of an anterior mediastinal mass was made with TEE. The place of TEE may be indicated in patients with unexplained hypoxemia and hypotension.