بررسي 22 مورد تومور مدياستن در كودكان با تظاهرات حاد تنفسي

The study of 22 cases of mediastinal tumors in children with acute respiratory manifest tation

Introduction: Intrathoracic tumors in children often occure in anterior mediastinum where the rate of malignancy is high. Flexible airway with small diameter in children may lead to acute respiratory emergency. In this study we evaluated (age, sex, clinical and radiological signs, site of tumor in mediastinum, way of diagnosis, type of pathology, treatment and 6 months survival), and also we assessed the effective factors that led to acute respiratory emergency in children. Materials and Methods: This is a retrospective study of the patients who were under 15 years old with mediastinal tumor and treated with a net pathologic diagnosis and followed for at least 6 months in Mashhad Ghaem and Omid hospital from 1994 to 2004, then we compared 2 groups (with and without acute respiratory emergency), and we assessed the effective factors. Results: 22 patients consisted of 55% male and the most common age group was 5-10 years (45.5%). 13% of patients were asymptomatic and 16% of them had minor respiratory symptoms such as cough and dyspnea and 27% of them had acute respiratory emergencies. The most common sign was fever (45%) and 45% of these tumors were in anterior mediastinum, 37% in posterior mediastinum and 18% in middle mediastinum. The most common method of diagnosis was anterior mediastinotomy (41.5%). 72% of these tumors were malignant, the most common malignancy was lymphoma (41%). Effective factors for acute respiratory emergencies included, being of tumor in anterior mediastinum, persisting of signs of pressure on airway and great vessels (superior venacava syndrome) and pleural effusion. In this study, mortality rate was 9% during 6 months after diagnosis which all of these patients were in the group with acute respiratory emergencies. Conclusion: According to high rate of malignancy in children with mediastinal tumor and probable acute respiratory emergency with high mortality rate in them, we recommend accurate investigation in these patients before any kind of diagnosis and treatment decision by a team of specialists (pediatrician, ENT, thoracic surgeon, oncologist and anesthesiologist) to find the best method of diagnosis and treatment for these patients and decrease the complications and mortality rate.