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[2 children with stridor and a thymus in the posterior mediastinum]
P W van Mossevelde1, R Severijnen, C Hitge-Boetes
1Afd. Kindergeneeskunde, Academisch Ziekenhuis Nijmegen.
Insights
Aberrantly located thymus in infants can cause posterior mediastinal masses and stridor. Magnetic resonance imaging (MRI) aids noninvasive diagnosis, avoiding exploratory surgery.
Area of Science:
- Pediatric Surgery
- Thoracic Surgery
- Diagnostic Imaging
Background:
- Posterior mediastinal masses in infants can present with severe respiratory distress, including stridor and apnea.
- Diagnostic challenges arise when initial investigations fail to identify the etiology of such masses.
- Aberrant thymic tissue is a rare but significant cause of mediastinal abnormalities.
Observation:
- Two infants presented with stridor and apnea, with X-rays revealing posterior mediastinal masses.
- Initial diagnostic thoracotomy identified aberrant localized thymus in both infants.
- Persistent stridor post-surgery indicated an underlying issue beyond the thymic mass.
Findings:
- The primary cause of persistent stridor was tracheomalacia, both primary and secondary.
- Aberrantly positioned thymus can mimic other posterior mediastinal masses.
- Magnetic resonance imaging (MRI) offers a noninvasive method for diagnosing posterior mediastinal thymic masses.
Implications:
- Early consideration of aberrantly positioned thymus in the differential diagnosis of posterior mediastinal masses is crucial.
- Noninvasive imaging like MRI can prevent unnecessary invasive procedures.
- Accurate diagnosis of the underlying cause, such as tracheomalacia, is essential for effective treatment in infants with mediastinal masses.
Abstract:
Two infants are described with an inspiratory and expiratory stridor with apnea. X-ray examination showed a mass in the posterior mediastinum. For this reason both infants underwent a diagnostic thoracotomy because detailed study didn't resolve the problem. An aberrant localized thymus was found in both infants. In both infants, however, the complaints persisted after the operation. Both infants needed a second operation to relieve the stridor, which appeared to be due to (primary and secondary) tracheomalacia. This article describes shortly the embryology of the abnormally located thymus. The possibilities to diagnose a posterior mediastinal mass without thoracotomy are also described. Using magnetic resonance imaging (MRI), the posterior located thymus can be diagnosed noninvasively in most cases. The aberrantly positioned thymus should be included in the differential diagnosis of a posterior mediastinal mass, otherwise invasive methods are needed to come to the good diagnosis.