[Management for Life-threatening Mediastinal Tumor]

Mediastinal tumor occasionally causes life-threatening symptoms by infection, enlargement, and invasion to intrathoracic organs requiring an emergent treatment, while routine chest computed tomography (CT) can increasingly lead to incidental diagnosis of an asymptomatic mediastinal tumor. Cystic teratoma is one of the mediastinal tumors with lethal symptoms by rupture into the intrathoracic organs and/or cavities. Emergent tumor resection should be recommended when clinical characters suggest the diagnosis. Mediastinal tumors can cause airway stenosis by direct invasion and/or compression. Urgent airway reconstruction either by bronchoscopic interventions including stent or by surgery depends on causative diseases. Anterior mediastinal tumors such as thymic tumors can cause superior vena cava (SVC) syndrome. SVC reconstruction using a grafting method followed by radical tumor resection is recommended when the thymic epithelial tumor can be resectable. SVC reconstruction can provide a good quality of life and subsequent adjuvant therapy to some patients with the tumor responding to chemo-radiation therapy, even when the tumor is unresectable. The treatment strategy for lethal mediastinal tumors should be planned by physicians, radiologists and anesthesiologists other than thoracic surgeons.