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Published on: January 12, 2019
[CLINICAL AND DIAGNOSTICS ASPECTES OF BENIGN MEDIASTINAL FORMATIONS IN CHILDREN]
B Kravchuk1, V Getman1, P Sokur1
1P.L. Shupyk National Medical Academy of Postgraduate Education, Ministry of Healthcare of Ukraine, Department of Thoracic Surgery and Pulmonology, Kiev, Ukraine.
Insights
Mediastinal masses in children often present with compression symptoms, but some are asymptomatic. Early diagnosis via radiography and advanced imaging, followed by surgical removal, is crucial for effective treatment.
Area of Science:
- Pediatric Thoracic Surgery
- Diagnostic Imaging
- Clinical Manifestations
Background:
- Over 730 pediatric patients (3 months-18 years) with mediastinal formations were treated between 1995-2018.
- Benign tumors comprised the main group, with 294 patients.
- Analysis focused on clinical presentation and disease progression.
Purpose of the Study:
- To analyze clinical symptoms and disease courses of mediastinal formations in children.
- To identify diagnostic methods and risk factors for pediatric mediastinal masses.
- To establish surgical removal as the primary treatment modality.
Main Methods:
- Systematic analysis of patient complaints, medical history, and clinical symptoms.
- Utilized chest radiography (WGC), CT, MRI, ultrasound, and infrared thermography for diagnosis.
- Surgical intervention for mass removal.
Main Results:
- Two clinical courses identified: asymptomatic (13.3%) and typical, characterized by mediastinal compression syndrome.
- Typical course presented with indistinct and organ-specific symptoms (respiratory, hemodynamic, dysphagia, neurogenic, osteogenic).
- Malignant or suppurated masses showed intoxication and pain; airway compression led to "local immobilization" and respiratory symptoms.
Conclusions:
- Early radiography and advanced imaging are key for diagnosing pediatric mediastinal masses.
- Infrared thermography offers a highly informative and accessible diagnostic approach.
- Surgical excision remains the sole radical treatment for mediastinal structures.
Abstract:
There were more than 730 patients aged 3 months to 18 years with formations of the mediastinum, treated in Pediatric Clinic of Thoracic Surgery NMAPE P. L. Shupyk during the period from 1995 to 2018. The main group with benign tumors consisted of 294 patients. Complaints, life history of the disease, and clinical symptoms were studied, systematized and analyzed. Two varieties of the clinical course of mediastinal structures: asymptomatic and typical were identified. Asymptomatic was recorded in 39 (13.3%) patients. Typical course of mediastinal structures was clinically manifested by mediastinal compression syndrome of varying severity. Analysis of clinical data in a typical course of the disease allowed us to distinguish two periods: indistinct (limited) and organ-specific manifestal symptoms. In conditions of preferential organs or structures of the corresponding system compression, the top five organ specific symptoms were defined: respiratory, hemodynamic, dysphagy, neurogenic, osteogenic. Entities, transformed into malignant forms or complicated by suppuration, except compression, are characterized by: total intoxication and pain symptom. In case of primary airways (trachea, bronchus) compression, in limited organ specific symptoms pathogenesis period, the "local immobilization" link is indicated respectively to localization of pathologic entity, as the first level of airways compression and as a trigger mechanism of aerogenic (respiratory) symptom in this group of patients. Possible signs and risk group of children to have mediastinum entity was identified. Early WGC radiography survey in two projections is the main objectifying method, and computer, magnetic-resonance imaging and ultrasound scanning are the main diagnostic methods. Infrared thermography is highly informative and easy-going method for diagnosis of mediastinal structures. Surgical removal of mediastinal structures is the only radical method of treatment.
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