Intrathoracic Tumors

Abstract

THERE are many disease conditions which may be found within the thoracic cavity and which must be considered when speaking of intrathoracic tumors. Some of these conditions are: Intrathoracic thyroid, thymus enlargement, aneurysm, carcinoma of esophagus, diverticulum of esophagus, malignant tumor of mediastinum, sarcoma and carcinoma of lung, abscess of lung, abscess of mediastinum, Hodgkin's disease, inflammatory glandular enlargement, tumor of chest wall, pleural effusion, and diaphragmatic hernia. The choice of treatment depends on the diagnosis, and, therefore, we must endeavor to be accurate. The X-ray has proven a most valuable aid in the diagnosis of all chest diseases and yet we find that it is sometimes impossible to make a positive differential diagnosis. In the recent literature we find a report of a case in which a mediastinal abscess was found where sarcoma had been diagnosed, and in another instance an aneurysm found where tumor had been diagnosed. A patient recently came under our care who had been receiving high voltage roentgen therapy over a period of many months for what was thought to be a large mediastinal tumor. This proved to be an aneurysm. Tumors of the thoracic wall have been diagnosed as syphilis when the Wassermann reaction was positive, yet the tumor was afterwards found to be a sarcoma. The patient whose history I wish to report was at first supposed by his physician to have a large left-sided pleural effusion. The roentgen examination substantiated his diagnosis. After a considerable amount of fluid had been aspirated the physical signs showed very little change and the roentgen examination showed the left side as cloudy as it had been before the aspiration. On further examination a solid mass could be felt with the aspirating needle and a large intrathoracic tumor was suspected. On subsequent roentgen examination the heart and trachea were found displaced to the right to a very marked degree, the right lung being so encroached upon that apparently only about one-half its usual space was left for it. The patient showed considerable cyanosis and was delirious at times. An attempt at removal of the tumor was decided upon and the first of a two-stage operation done under local anesthesia on November 7, 1927. The second operation, also under local, was done November 12, 1927. On opening the thoracic cavity it was found that the tumor filled the entire left thorax and even depressed the left diaphragm so that it was concave instead of convex. The tumor was delivered with some difficulty on account of its great size and also because of the presence of some adhesions to the posterior chest wall and lung. At this point a general anesthetic was given for a short time. There was a comparatively small pedicle, broad and narrow, which was clamped, ligated, and cut. The field of operation was closed with drainage. The patient made an uneventful recovery and is very well to-day, over a year after his operation.