Anesthetic management of cesarean section in a patient with a large anterior mediastinal mass: a case report

BACKGROUND: Symptomatic anterior mediastinal mass in pregnancy is rare, and cesarean section for such patients poses a risk of cardiopulmonary collapse. CASE PRESENTATION: A 30-year-old woman at 40 weeks’ gestation complained of breathlessness and cough, and she was not able to lie supine because of respiratory distress. Computed tomography scan revealed a large anterior-superior mediastinal mass severely compressing the trachea, bilateral main bronchus, and superior vena cava. Because clinical symptoms and computed tomographic findings suggested imminent respiratory catastrophe, urgent cesarean section was planned. The patient was able to lie in the semi-recumbent position with minimal symptoms; therefore, we considered it safe to perform cesarean section with combined spinal epidural anesthesia. In the event of cardiopulmonary collapse, emergent intubation and extracorporeal membrane oxygenation were also planned. The operation was performed successfully with combined spinal epidural anesthesia. The infant was healthy, and the postoperative hospital course was uneventful. CONCLUSIONS: Combined spinal epidural anesthesia is preferable in the anesthetic management of cesarean section with symptomatic anterior mediastinal mass. A well-designed preoperative strategy can lead to favorable outcomes even in this complicated situation.