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Mediastinal Cystic Teratoma With Bronchial Fistula FREE TO VIEW

Aurelio Wangüemert Pérez, MD; Rita Gil, MD; Sergio Fumero, MD; Helena Hernandez Rodriguez, MD; Jose Maria Hernandez Perez, MD; Raquel Rodriguez Delgado, MD; Nuria Manes, MD
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Hospital Universitario de Canarias, La Laguna, Spain

Chest. 2014;145(3_MeetingAbstracts):306A. doi:10.1378/chest.1825868
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SESSION TITLE: Cancer Case Report Posters II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, March 23, 2014 at 01:15 PM - 02:15 PM

INTRODUCTION: Mediastinal Teratoma is a benign tumor with rare complications. On very few occasions its rupture can produce mediastinitis, fistula to the pericardium, pleura or bronchus. Our aim was to report the evolution of a patient with a cystic teratoma with bronchial fistula.

CASE PRESENTATION: A 59 year-old woman, with frequent respiratory infections treated with antibiotics, attended the emergency department for fever of 40 °C, non-productive cough, pleuritic chest pain and dyspnea on effort Physical examination, was normal. Chest X-ray showed a rounded cystic mass in the right hemithorax. Chest CT showed a 43x32x25 mm mass adjacent to the ascending aorta, before the superior vena cava. Immediately below and posterior, there was a similar lesion with an area of increased density related to linear atelectasis. This was a bilobular hypodense lesion. Bronchoscopy: structural alteration impeded middle lobe access. Cytology and bronchial biopsy: no malignancy. Culture: H. parainfluenzae and Aeromonas salmonicida. Despite antibiotic treatment showed the same radiological signs. Previous X-Rays showed similar findings. While awaiting scheduled thoracic surgery, the patient had two episodes of pneumonia of the middle lobe. Surgery: Right video-assisted thoracotomy (VATS): A thick-walled cystic mass in direct contact with middle lobe bronchus with fistula and atelectasia. Middle lobe and mass resected. Mass content hairy and caseous. Evolution and Results: Favorable follow-up to date (4 months), without respiratory infection.

DISCUSSION: Teratomas are benign tumors , that in a vast majority are asymptomatic and are discovered incidentally. When this is so the best treatment is resection to avoid risk of complications and degeneration.

CONCLUSIONS: 1.-Mediastinal teratoma is rarely symptomatic. In some cases it generates a fistula to the pericardium, mediastinum, lung or bronchus, producing acute mediastinum. 2.-Symptoms and/or fistula to the airway are indications for surgery with good prognosis.

Reference #1: Benign cysts of the mediastinum: series of 28 cases. Rev Mal Respir. 2012 Nov;29(9):1111-5

Reference #2: Mediastinal mature teratoma with complex rupture into the lung, bronchus and skin: a case report. World J Surg Oncol. 2013 Jun 1;11:125. Serraj M, Lakranbi M, Ghalimi J, Ouadnouni Y, Smahi M.

DISCLOSURE: The following authors have nothing to disclose: Aurelio Wangüemert Pérez, Rita Gil, Sergio Fumero, Helena Hernandez Rodriguez, Jose Maria Hernandez Perez, Raquel Rodriguez Delgado, Nuria Manes

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