A four-year-old girl was brought by her parents to American Hospital Dubai for a second opinion. She had been having a fever and cough for 10 days, and the previous hospital her parents consulted administered her paracetamol, antibiotics and a Pulmicort nebulizer, believing her condition to be bronchitis. Though her fever was controlled, her cough persisted, and the little girl’s parents decided to seek help at American Hospital Dubai.
Dr Ahmad Alsweed, Consultant Paediatric Surgeon at American Hospital Dubai, decided to immediately do a chest X-ray for the little girl, which revealed a large, rounded, mass-like lesion in her right posterior mediastinal region. The mediastinum is the space inside the chest between the two lungs that holds the heart and related structures. The little girl appeared to have a lesion in the posterior area, or at the back, of the right side in this space between the lungs.
Dr Alsweed decided to do a CT Chest. After discussions with the tumour board, the consensus was also to do a CT-guided biopsy, which showed the lesion to be a big-sized, rare tumour diagnosed as a Ganglioneuromatous neoplasm or an abnormal growth in the nerve cells.
The tumour board re-discussed the case and decided that the little girl needed a thoracotomy to remove the tumour. A thoracotomy is a surgical procedure that makes an incision in the chest to reach the lungs or other organs in the chest or thorax. The tumour removal would not benefit from thoracoscopy or robot surgery because the mass was large and solid and required an extra-long incision to extract it out of the chest.
It was a challenging surgery. The tumour was big, and it was located near the main blood vessels in the thoracic region. Additionally, the tumour’s size was causing a significant widening of the space between the affected ribs, creating bone scalloping or a change in the curvature of the bone in the vertebrae and impacting the mediastinal structures such as the air passageways in the lungs.
There were also several risks associated with such a challenging procedure, including bleeding, injury to the bronchus (a large airway from the windpipe or trachea to a lung) and the possibility of an incomplete mass or tumour removal.
In the expert hands of Dr Alsweed – a specialist in paediatric thorax surgery, oncologic surgery, paediatric urology, neonatology and congenital malformations surgery, American Hospital Dubai – and with the help of Dr Ahmad Abdulaziz, Paediatric Anesthesiologist, and Dr Mehran Karimi, Paediatric Oncologist, at American Hospital Dubai, the three-hour procedure was a complete success. The big-size tumour measuring 7.5x7x4.5cm was removed entirely, eliminating the need for chemotherapy.
The patient was discharged after three days and is on her way to full recovery.
