Prenatally Dx large mediastinal lymphangioma: A case report
A 29‐year‐old mother (gravida 1, para 1) was referred to the Department of Obstetrics in our hospital because fluid collection in the thoracic cavity was detected by fetal ultrasonography at the 33 weeks of gestation. Fetal MRI revealed a large cystic lesion in the anterior mediastinum, surrounding the heart and large vessels. It occupied more than half of the thoracic cavity, compressing the bilateral lungs backward.

As the fetal ultrasonography demonstrated a few septums inside the cystic lesion, lymphangioma was most likely the diagnosis. Judging from the size and location of the lesion, postnatal respiratory distress seemed inevitable. Based on a discussion among gynaecologists, neonatologists it was planned to deliver the baby by Caesarian section around the term period (if the well‐being of the fetus was maintained), with prompt postnatal resuscitation with ultrasonography‐guided percutaneous drainage on site.

On MRI, the fetal trachea seemed straight without a mass effect caused by the lesion, so endotracheal intubation immediately after birth seemed feasible. The delivery was planned for the 37 weeks of gestation. The lesion gradually became enlarged, and the mother was hospitalized at 35 weeks and 6 days of gestation. The fetal cardiac output measured by echocardiography decreased from 504 mL/kg/min (gestational age: 33 weeks) to 246 mL/kg/min (gestational age: 36 weeks), and a small amount of pleural effusion and ascites was noted. The baby was delivered by Caesarian section with neonatologists by at 37 weeks and 2 days of gestation.

While the male neonate with apnea and bradycardia was resuscitated by the neonatologists the team—divided into two subteams—scanned his left and right chest with ultrasound and noticed large fluid collection, and marked the appropriate puncture sites. Percutaneous tube drainage was performed under local anesthesia at the left and right anterior axillary lines at 2 and 6 minutes after birth, respectively.

Approximately 250 mL of serous content was drained soon after the procedures. While the content was drained, the neonate pinked up well. The Apgar scores at 1 and 5 minutes were 5 and 8 points, respectively. He was transferred to the Pediatric Intensive Care Unit in a stable condition. The drainage was minimal thereafter, and cytology indicated that the content was lymphocyte‐dominant. The left and right mediastinal drains were removed at 2 and 9 days of age, respectively.

His cardiopulmonary function was quite stable and he was weaned off the ventilator at 6 days of age. Contrast‐enhanced computed tomography taken after the two drains were removed revealed a small amount of fluid collection in his anterior mediastinum.

Follow‐up studies with ultrasound and chest X‐ray revealed that the volume of the mediastinal fluid collection was consistent, and he was discharged to home at 20 days of age. Treatment with Eppikajutsuto at a dose of 0.2 g/kg/d, was started at 29 days of age, and the patient remained clinically stable without an increase in fluid volume during 20 months of follow‐up.

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