Anterior Mediastinal Mass

Question 1

Anterior Mediastinal Mass: Periop cardiopulmonary complication risk factors

Answer 1

1. Presyncope with supine positioning (risk CV collapse)
2. Tracheal compression >50% (risk complete airway collapse)
3. Tracheal compression >30% + bronchial compression
4. Stridor
5. Orthopnea
6. Cyanosis
7. JVD
8. SVC syndrome
9. Effusion: pericardial or pleural
10. Combined obstructive and restrictive pattern on PFTs

Question 2

Symptoms of Airway Compression

Answer 2

Dyspnea
Tachypnea
Wheezing

Question 3

Anterior Mediastinal Mass: Risk factors for tracheal collapse

Answer 3

Direct mass compression
Forced expiration (positive intrathoracic pressure)
Increase negative intraluminal pressures (SV in presence of partial airway obstruction)

Question 4

Anterior Mediastinal Mass: Would you order an Echo?

Answer 4

CT scan demonstrated pericardial effusion or possible compression of CV structures

Order upright and supine positions

Question 5

Anterior Mediastinal Mass: Would you order flow volume loops/PFTs?

Answer 5

No.
1. Poor predictors of periop respiratory complications
2. Provide little additional info to CT scan
3. Would not alter anesthetic plan
I would require a recent CT scan and perform H&P -observing patient in sitting and supine positions

However, some anesthesia providers would order

1. Effects of positioning on PFTs
2. Obstruction Location (intra versus extrathoracic) and Nature (fixed vs variable)
3. Reversible component

Question 6

Flow Volume Loops

Answer 6

plots
Inspiratory and expiratory airflow on Y axis
against
Flow volumes on the x axis
during performance of max forced inspiratory (TLC) and expiratory (RV) maneuvers

Question 7

Anterior Mediastinal Mass: SOB Causes

Answer 7

Mass compression of airways
- VP mismatch
- Post obstructive PNA
Mass compression of heart or great vessels
- Direct cardiac compression
- Pericardial effusion
- SVC syndrome
- Pulmonary artery compression