Mediastinal Masses and Sternotomies: A Case Series

Mediastinal masses or cervical masses with mediastinal extension can pose technical challenges when resection is chosen as the intervention of choice. In modern medicine, there are high volumes of minimally invasive approaches, and open surgery is becoming less common. Differentials for mediastinal masses include thymic tumors, thyroid masses, lymphomas, nerve tumors, and bronchogenic lesions, to name a few. The authors describe two open approaches to mediastinal lesions, including a thyroid with mediastinal extension and a paraganglioma, which were both resected via the open approach through sternotomy and hemi-sternotomy. The first case was an 83-year-old female with a large thyroid goiter causing globus sensation and a workup consistent with a large thyroid goiter with mediastinal extension near the tracheo-esophageal groove, requiring sternotomy for resection. The second case was a 50-year-old male with a history of unprovoked deep vein thrombosis (DVT) incidentally found to have a mediastinal lesion between the left subclavian and left common carotid artery, which was growing in size. Resection was offered after a thorough workup. A robotic approach was offered and attempted; however, this was aborted in the setting of arterial bleeding. The patient ultimately required hemisternotomy and resection with postoperative complications of hydropneumothorax requiring tube thoracostomy and pulmonary embolism requiring therapeutic anticoagulation.  While both ultimately had successful resection, the older patient with sternotomy suffered no postoperative complications as compared to the younger male with the hemisternotomy. Nonetheless, this series highlights two cases where an open approach was required through sternotomy and hemisternotomy with successful resection of mediastinal masses.