Superior Mediastinal Syndrome Misdiagnosed as Foreign Body Aspiration: A Case Report

Abstract

Superior mediastinal syndrome is a life-threatening pediatric oncological emergency that requires high level of awareness and clinical suspicion to avoid misdiagnosis and devastating outcomes. Early diagnostic evaluation and management of underlying etiology are of utmost significance for optimal results. In children, it is most commonly caused by non-Hodgkin's lymphoma and T-cell lymphoblastic leukemia. We report a case of a six-year-old boy with superior mediastinal syndrome secondary to T-cell acute lymphoblastic leukemia, initially misdiagnosed as foreign body aspiration and underwent a procedure with a life-threatening outcome.

Keywords: Chemotherapy; Lymphoblastic Leukemia; T-cells; Vena Cava, Superior.

Figure 1

Imaging before treatment. (a) Chest X-ray showing a large mediastinal mass in the region of the superior mediastinum and the patient was intubated. (b) CT showing a large soft tissue density mass lesion and is resulting in compression of the superior vena cava and was slit-like on the axial image (red arrow). (c) CT coronal reformation redemonstrating a large soft tissue density mediastinal mass.

Figure 2

Imaging after treatment. (a) Chest X-ray showing reduced size of the superior mediastinal mass and endotracheal tube was removed. (b) CT showing reduction in the size of soft tissue density mass lesion in the superior mediastinum. There was a significant improvement in earlier seen compression of SVC and now showing better caliber on the axial image (red arrow). (c) CT coronal reformation showing reduction in the size of earlier seen mediastinal mass.