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Walking a tightrope - A multitude of airway challenges in a mediastinal mass excision

S Gajalakshmi1, Shreya B Shah1, Vishesh Jain2

  • 1Department of Anaesthesiology, Pain Medicine and Critical Care, All India Institute of Medical Sciences, New Delhi, India.

Lung India : Official Organ of Indian Chest Society
|October 23, 2025
PubMed

Insights

Managing infant airway challenges during video-assisted thoracoscopic surgery requires personalized approaches. This case highlights complexities in lung isolation and recurrent laryngeal nerve protection for infants with bronchogenic cysts and tracheobronchomalacia.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Anesthesiology

Background:

  • Lung isolation in infants undergoing video-assisted thoracoscopic surgery (VATS) presents unique challenges due to limited ventilation options.
  • Anatomic abnormalities, such as tracheobronchomalacia, further complicate airway management in infants.

Purpose of the Study:

  • To outline the intraoperative airway challenges encountered in a 10-month-old infant with a recurrent bronchogenic cyst.
  • To contribute to the literature on managing complex airway cases in infants undergoing VATS.

Main Methods:

  • Case report of a 10-month-old infant undergoing video-assisted excision of a recurrent bronchogenic cyst.
  • Detailed description of airway management strategies tailored to the infant's specific anatomy, including severe tracheobronchomalacia and proximity to recurrent laryngeal nerves.

Main Results:

  • Successful video-assisted excision of the recurrent bronchogenic cyst was achieved.
  • The personalized airway management approach mitigated risks associated with tracheobronchomalacia and recurrent laryngeal nerve injury.

Conclusions:

  • Infants with complex airway pathologies require individualized surgical and anesthetic plans for VATS.
  • Careful consideration of anatomic derangements is crucial for optimizing patient outcomes in pediatric thoracic surgery.

Keywords:
Bronchogenic cystinfantintraoperative bronchoscopyintraoperative nerve-monitoringlung isolationtracheo-bronchomalacia

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