[Acute respiratory failure and mediastinal mass syndrome]

A 46-year-old female with a history of a chronic obstructive lung disease was intubated by the emergency physician for acute respiratory failure. However, after intubation she developed circulatory failure and required cardio-pulmonary resuscitation. The reason for the circulatory failure following muscle relaxation and intubation was identified as a mediastinal mass syndrome. Chest X-ray and computed tomography revealed an apical right-sided large tumor of 8 x 8 cm, which displaced the V. cava superior and caused obstruction of the inferior trachea and right main stem bronchus. She underwent surgery in our institution on the following day and the tumor could be removed completely. Patho-histologic examination verified the diagnosis of a Schwann cell tumor. After stepwise reduction in airway pressures, the patient was successfully weaned from the ventilator without neurologic deficit. About 24 h later she was transferred to the normal surgical ward. A mediastinal tumor with airway and central venous obstruction may be a rare cause of acute respiratory and circulatory failure.