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DOI: 10.1055/s-0032-1332676
Operation at risk: Excision of an extensive bronchogenic cyst without cardiopulmonary bypass in a 30-month old
Introduction: Mediastinal tumors in children may cause recurrent pulmonary infection and respiratory difficulty due to airway compression. Chest x-ray and transesophageal echocardiogram enable valuable and quick diagnosis of bronchogenic cysts in the mass. We report on elective excision of an extensive bronchogenic cyst compressing the left main bronchus without the use of cardiopulmonary bypass.
Aims: A 30-month old boy (11 kg) had been presenting with frequent cough, recurrent fever and episodes of pulmonary infection for over 8 months. Chest x-ray and transesophageal echocardiogram revealed an extensive bronchogenic cyst. As conservative treatment failed to improve respiratory difficulty and the cyst continued to increase in size the boy was admitted to surgery. Preoperative magnetic resonance imaging showed a large mediastinal tumor (3.2 cm x 2.1 cm, fig.1C).
Fig. 1: Excision of An Extensive Bronchogenic Cyst
Median sternotomy was undertaken. The mediastinal mass could be exposed after mobilization of the aortic arch, descending aorta and the pulmonary artery (fig. 1A, *). Ligamentum arteriosum was transsected. Step by step with retraction of the aorta the cystic mass was dissected and separated from the pulmonary arteries and left main bronchus. Finally, the mass could be excised in toto without destroying the fragile and thin wall (fig. 1B and D). Procedure time was 135 min. Extracorporeal circulation was in standby-state during the whole operation. The patient's recovery was uneventful. The patient was extubated the same day and did not receive any blood transfusions or catecholamines. Pathology showed a multiloculated cyst with respiratory epithelium. The postoperative course was uneventful and the boy was discharged 7 days after surgery in good general condition.
Discussion: Recurrent pulmonary infection and failure to thrive may indicate an open excision of mediastinal tumors. Our report underlines that even an extensive mass may be excised as a whole without the risk of extracorporeal circulation.