Anesthetic Management of a Giant Thymolipoma Causing Near Total Lung Collapse: A Case Report

Thymolipoma is a rare benign anterior mediastinal tumour. Although often clinically silent, it can lead to significant pressure effects on the airway, mediastinal structures and great vessels. Anaesthesia induction and the use of muscle relaxants in such patients may precipitate airway collapse and difficult bag-mask ventilation due to the size, location and weight of the mass. Haemodynamic instability, arrhythmias and injury to vital structures contribute to the perioperative challenge. Major postoperative concerns include pain management and reduction of postoperative pulmonary complications (PPC), including re-expansion pulmonary edema. We report a case of massive anterior mediastinal thymolipoma . The growth caused marked mediastinal displacement to the right, compression of the left main bronchus, complete collapse of the left lung and partial collapse of the right lung. Despite this, the patient remained asymptomatic at rest, maintaining an oxygen saturation of 89% on room air. Anesthetic management involved controlled induction rather than awake intubation, reflecting a preparedness-based strategy with extracorporeal membrane oxygenation and rigid bronchoscopy available on standby, guided by the patient's clinical stability and radiological assessment, rather than an avoidance-based approach.