Narayana Health SRCC Children’s Hospital, Mumbai, has successfully treated a two-year-old girl with a complex and superior mediastinal mass extending into the neck, which was causing significant airway compression and respiratory distress. The girl,Shruti (name changed for confidentiality) had been suffering from neck stiffness, swelling and mild breathing difficulty for the past four to five months.
Her parents had noticed noisy breathing and an increasing breathlessness, accompanied by a change in the girl’s voice , especially during infections and while lying down. These early warning signs led the parents to urgently seek medical care. A Clinical examination upon presentation at Narayana Health SRCC Children’s Hospital, Mumbai, revealed tracheal deviation, prompting immediate investigation.
Given the girl’s young age, even minimal airway compromise posed a significant threat. Advanced imaging, including ultrasound and contrast-enhanced CT scans, identified a complex anterior mediastinal mass arising from the thymic region and extending into the neck. The rare and complex mass was closely related to vital structures within the mediastinum and neck. It was compressing and displacing the trachea, causing significant airway narrowing and placing the child at constant risk of respiratory distress.
A multidisciplinary paediatric team led by Dr. Rasikal Shah, Senior Consultant – Paediatric Surgeon, Narayana Health SRCC Children’s Hospital, Mumbai along with Dr. Pradeep K. Kaushik, Senior Consultant –Paediatric Cardiac Surgery, Narayana Health SRCC Children’s Hospital, Mumbai, planned the surgical intervention. The team of paediatric anaesthesiologists, led by Dr. Nandini Dave, Senior Consultant- Paediatric Anaesthesiology, Narayana Health SRCC Children’s Hospital, Mumbai, took care of anaesthesia and airway during surgery. Special attention was given to airway management due to the high risk of obstruction during anaesthesia in young children with mediastinal masses.
During surgery, an intraoperative ultrasound revealed solid components, requiring an immediate change in strategy. The team decided to proceed with a median sternotomy to ensure complete and safe excision of the mass while protecting vital structures. Histopathological analysis confirmed the mass to be benign, with features of myxoma/myxolipoma.
Talking about the case, Dr. Rasiklal Shah said, “Mediastinal masses in young children pose significant surgical and airway challenges. This case required precise intraoperative decision-making and close coordination among multiple specialities to achieve a safe outcome.”
Adding further about the case, Dr. Pradeep Kaushik mentioned, “Early recognition of airway compromise and flexibility in surgical planning were key factors in the successful management of this child.”
The surgery involved meticulous dissection to safeguard the trachea, thymus and major mediastinal vessels, with minimal blood loss, and prevent damage to these critical structures. Postoperatively, the girl was closely observed till she made a smooth recovery and was discharged in a stable condition.
