L-shaped sternotomy for the resection of a large thoracic tumor in a 10-year-old child: a case report

Introduction

In pediatric patients, large intrathoracic tumors have a broad differential and varied presentation. Based on patient anatomy, the size of the tumor, and malignant potential, adequate intra-operative exposure must be balanced with long-term functional recovery.

Case presentation

A previously healthy 10-year-old girl presented with a 2-month history of dyspnea, left shoulder pain, heart murmur, and significant weight loss. Physical examination revealed diminished breath sounds on the left side and a systolic murmur on auscultation, as well as an asymmetric chest. Elevated inflammatory markers were noted, with imaging showing a large heterogeneous tumor occupying most of the left thoracic cavity, 13.5 x 10.3 × 13.3 cm, including cystic and adipose tissue with calcifications. The tumor exerted mass effect on the left pulmonary vessels, lung, and left ventricle, causing mediastinal shift and pleural effusion. Surgical resection was performed using an L-shape sternotomy, with curvilinear left lateral extension in the anticipated inframammary crease and division of the 6th intercostal space, allowing complete en bloc excision without spillage. Pain management included intercostal nerve cryoablation, facilitating early mobilization out of bed, and minimizing the need for narcotic analgesia. Postoperatively, the patient recovered well, with pain managed by Tylenol, Ibuprofen, oxycodone, and Dilaudid. Follow-up after six months showed no recurrence of the tumor, and biopsies revealed a cystic mature teratoma with chronic inflammation in surrounding tissues.

Conclusion

The L-shaped sternotomy seems to be an effective approach for the resection of large thoracic tumors in children.