Life-threatening presentation of giant mature teratoma in a 9-year-old female: A case report

Introduction

Mediastinal teratomas are rare in children and adolescents; however, they often present diagnostic and therapeutic challenges, given their potential for malignancy. Rapid intervention, particularly surgical excision, is crucial for large, life-threatening masses following clinical stabilization.

Case presentation

A 9-year-old female presented with progressive left costal pain and dyspnea on exertion, culminating in acute respiratory failure prior to admission. Examination revealed a hypopigmented square patch in the left lower quadrant of the abdomen. Initial chest x-ray (CXR) showed complete opacification of the left lung with mediastinal shift to the right. Subsequent chest CT scan confirmed a 14.2cm × 11.2cm x 14.5cm complex, multiloculated, multiseptated mass suggestive of neoplasia. Local mass effect resulted in the obliteration of the left mainstem bronchi, left upper and lower lobe bronchi, lung atelectasis, and a large left pleural effusion. Surgical excision was planned following consultation with Pediatric Anesthesiology and Intensivist. The patient underwent left posterolateral thoracotomy through the fifth intercostal space, during which a large complex cystic mass (17.5 cm × 16.8 cm x 7.7 cm) arising from the thymus was excised after careful dissection from surrounding lung parenchyma and pericardium. Postoperatively, she recovered well in the Pediatric Intensive Care Unit (PICU) and was discharged on postoperative day #8 after pathology confirmed a benign teratoma.

Conclusion

Mediastinal teratomas in pediatric patients presenting with life-threatening signs and symptoms necessitate early recognition, involvement of a multidisciplinary team, and prompt surgical excision to ensure optimal outcomes.