Posttraumatic active bleeding of mediastinal mixed vascular malformation: a case report

Area of Science:

• Pediatric Surgery
• Vascular Malformations
• Trauma Management

Background:

• Mediastinal masses can present with life-threatening hemorrhage, particularly in pediatric trauma patients.
• Lymphatic-venous malformations (LVMs) are uncommon vascular anomalies, typically affecting the head and neck.
• Posttraumatic hemorrhage from mediastinal LVMs is exceptionally rare.

Observation:

• A 4-year-old boy with multitrauma presented with an actively bleeding mediastinal mass.
• Computed tomography (CT) scans revealed a mediastinal mass that enlarged over 3 days, correlating with a drop in hemoglobin.
• Surgical excision and pathological examination confirmed a lymphatic-venous malformation with hemorrhagic content.

Findings:

• The mediastinal lesion was diagnosed as a mixed vascular malformation, specifically a lymphatic-venous malformation.
• Sequential CT imaging demonstrated the dynamic enlargement and bleeding nature of the malformation.
• This represents the first reported case of posttraumatic mediastinal lymphatic-venous malformation with active bleeding in the English medical literature.

Implications:

• Highlights the importance of considering vascular malformations in pediatric trauma patients with unexplained bleeding and mediastinal masses.
• Emphasizes the utility of serial CT scans in assessing the dynamic nature of mediastinal hemorrhage.
• Contributes novel insights into the rare complication of posttraumatic hemorrhage from mediastinal lymphatic-venous malformations.