Intrapulmonary mature cystic teratoma presenting with haemoptysis treated with right middle lobectomy in a low-resource setting

Abstract

A teenage girl presented to our remote rural hospital with history of massive haemoptysis. A CT scan showed a spherical lesion in the right lung. Exploratory thoracotomy was performed with a provisional diagnosis of pulmonary hydatid cyst. Intraoperative findings were consistent with intrapulmonary teratoma and this was confirmed by a histopathological diagnosis of mature teratoma. Four years later, the patient presented again with recurrence of haemoptysis and a right middle lobectomy was performed. We present a report of successful management of this patient with 20-year follow-up since the first surgery, describe the pathology of this rare condition and the procedures used to treat it. We also discuss the social and economic factors that affect decision making in the management of rare conditions in remote rural areas among poor communities that are usually referred to tertiary hospitals and suggest modifications to protocols to provide effective treatment in spite of resource constraints.

Keywords: Anaesthesia; Cardiothoracic surgery; Global Health.

Figure 1

CT scan image at first presentation.

Figure 2

The Epstein-Mackintosh-Oxford apparatus (image used with permission from the Wood Library-Museum of Anesthesiology, USA).

Figure 3

Sebaceous material and hair removed at first surgery.

Figure 4

Timeline of presentations (graphic created by VAI).

Figure 5

Chest X-ray prior to second surgery.

Figure 6

Intraoperative photograph after middle lobectomy.

Figure 7

Chest X-ray 16 years after second surgery.