1. Mediastinal Mass Case Presentation By Anton McCourtie

2. 3yr Male with chronic sinusitis, chronic cough and recurrent otitis media. Concern for immotile cilia syndrome. 3yr Male with chronic sinusitis, chronic cough and recurrent otitis media. Concern for immotile cilia syndrome. Plan for ENT surgery including biopsy Plan for ENT surgery including biopsy Intubation Intubation Rigid chest, purulent secretions and blood noted in larynx Rigid chest, purulent secretions and blood noted in larynx

3. PMH PMH Chronic rhinorrhea since age 18months. Chronic rhinorrhea since age 18months. -ve Allergens -ve Allergens -ve Cystic fibrosis -ve Cystic fibrosis 7 courses of po antibiotics 7 courses of po antibiotics PSH PSH Tonsillectomy 2/09. No change Tonsillectomy 2/09. No change DH DH QVAR, albutarol, Flonase QVAR, albutarol, Flonase Allergies Allergies PCN PCN

5. WCC 25, Hct 25, Plt 418 WCC 25, Hct 25, Plt 418 CT Scan performed. CT Scan performed. Well defined round L Mediastinal mass with mass effect on L bronchus Well defined round L Mediastinal mass with mass effect on L bronchus

8. OR 9/18 for VAT biopsy/excision. OR 9/18 for VAT biopsy/excision. Converted to thoracotomy Converted to thoracotomy Procedure aborted Procedure aborted pH 7.34/46/87/25 pH 7.34/46/87/25

10. Discharge WCC 7, Hct 35, PLt 510

11. Mediastinal Cysts Clinical manifestations due to mass effect & influenced by position Clinical manifestations due to mass effect & influenced by position Infants may present with resp distress Infants may present with resp distress Older children with cough, chest pain or dyspnea Older children with cough, chest pain or dyspnea Rapid onset of symptoms noted in lymphomas Rapid onset of symptoms noted in lymphomas Posterior lesions may be asymptomatic Posterior lesions may be asymptomatic

12. Differential Anterior/Superior Mediastinum Anterior/Superior Mediastinum Germ cell Tumors Germ cell Tumors Thymic Lesions Thymic Lesions Lymphomas Lymphomas Middle Mediastinum Middle Mediastinum Pericardial Cysts Pericardial Cysts Posterior Mediastinum Posterior Mediastinum Foregut duplicatication cysts Foregut duplicatication cysts

13. Bronchogenic Cysts Definition Definition Develop from abnormal budding of tracheal diverticulum or ventral portion of foregut. Form a discrete mass of non functioning tissue Develop from abnormal budding of tracheal diverticulum or ventral portion of foregut. Form a discrete mass of non functioning tissue Histologically Histologically Lined by bronchial epithelium, contain mucous Lined by bronchial epithelium, contain mucous Diagnosis Diagnosis CXR helpful. CT scan usually confirms diagnosis CXR helpful. CT scan usually confirms diagnosis Management Management Excision Excision