Surgical case reports
Life-Saving Emergency Decompression via a Clamshell Approach for Cardiac Arrest Caused by Hemorrhage of a Giant Mediastinal Ectopic Thyroid: A Case Report
By Ono M, Watanabe Y, Togo T and 11 others.
Abstract
Introduction
Mediastinal ectopic thyroid tissue is rare and is usually asymptomatic. Intratumoral hemorrhage causing acute mediastinal compression and cardiac arrest is extremely uncommon. We report a case of cardiac arrest caused by hemorrhage of a giant mediastinal ectopic thyroid, successfully managed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) and emergency surgical decompression by tumor removal.
Case presentation
A 71-year-old woman with a long-standing anterior mediastinal tumor was transferred to our hospital because of dyspnea and shock after a fall. Contrast-enhanced CT revealed a giant anterior mediastinal tumor occupying the left hemithorax, with active extravasation and marked mediastinal deviation. Transarterial embolization was performed; however, she developed cardiac arrest shortly after embolization, presumably due to rapid tumor enlargement and severe mediastinal compression caused by intratumoral hemorrhage. Cardiopulmonary resuscitation was immediately initiated, and VA-ECMO was established. Emergency tumor removal and hemostasis were performed through a 4th-intercostal clamshell incision. The tumor occupied almost the entire left thoracic cavity and was extensively adherent to the chest wall and mediastinum, with particularly firm adhesion to the left brachiocephalic vein. The tumor was removed with combined resection of the left brachiocephalic vein. Histopathological examination revealed benign ectopic thyroid tissue without malignant findings. The postoperative course was complicated by bleeding, infection, acute kidney injury, and prolonged impaired consciousness. Postoperative hypothyroidism was identified after pathological confirmation of ectopic thyroid tissue, and levothyroxine replacement was initiated. The patient was transferred to a rehabilitation hospital on POD 72 and is currently living at home 1 year after surgery.