Avoidance of circulatory collapse by preoperative percutaneous drainage of tumor contents for a giant mediastinal mature cystic teratoma.

Abstract

Giant mediastinal tumors may cause fatal respiratory failure or circulatory collapse at the time of induction of general anesthesia and sometimes require extracorporeal life support. However, it is unclear whether preoperative percutaneous drainage of tumor contents for a giant mediastinal cystic teratoma reduces these risks. We report a case of a giant mediastinal cystic teratoma in which general anesthesia could be safely induced without extracorporeal life support by preoperative percutaneous drainage that reduced most of the tumor volume under local anesthesia. A 41-year-old woman diagnosed with a ruptured giant mediastinal teratoma required urgent surgery. To avoid circulatory collapse, preoperative percutaneous drainage of the tumor contents was performed, which successfully evacuated most of the tumor volume. General anesthesia was induced without any problem, and mediastinal tumorectomy was performed. We argue that it is worth attempting percutaneous drainage of tumor contents before cannulation of extracorporeal life support.