Successful Removal of 600 gm Lesions From A 5-Year-Old Female Child Through Thoracoscopic Surgery
Doctors at Dr. Mehta’s Hospitals achieved a medical milestone by performing thoracoscopic surgery on a 5-year-old girl, successfully removing 600 grams of lesions. This accomplishment lies in being the first in India to employ a technically challenging thoracoscopic technique, which demands more precision and expertise in managing pediatric giant thymolipoma.
A young girl, aged 5, was presented with the rare and challenging condition of the formation of lesions within her thoracic cavity.
She was previously diagnosed with Giant Thymolipoma, which initially came to the hospital after an incidental discovery of the condition during admission for dengue fever at an outside hospital. She has a history of fatigability over the past year, particularly after minimal to moderate physical activity.
A chest X-ray revealed a complete opacity with minimal sparing of the left apex, prompting further investigation through a CT scan. This scan indicated a bilateral mediastinal heterogeneous mass (L-S), which aroused suspicions of Giant Thymolipoma or liposarcoma. The child reported she doesn’t experience symptoms like fever, loose stools, ear discharge, rashes, urinary disturbances, altered level of consciousness, seizures, or bleeding manifestations.
The child’s vitals were stable upon examination. Respiratory examination, however, revealed reduced air entry on the left side. A subsequent CT scan of the chest unveiled a well-defined lesion with soft tissue density and streaks of fat in the anterior mediastinum, measuring 7.5x16x11 cm (APxTRxCC).
The child was admitted to Dr Mehta’s Hospitals for surgical intervention to treat the Giant Thymolipoma through video-assisted thoracoscopic surgery. During the procedure, the left thoracic cavity was entered through 5 mm ports at the 3rd and 5th intercostal spaces over the anterior axillary veins, and a massive thymolipoma was observed – which was occupying the entire left hemithorax. Dense adhesions were observed between the lesion and the pericardium (sac around the heart).
The surgical team preserved the phrenic nerve and delineated the lesion’s capsule, encountering dense adhesions to the left hilum. Delineated the vascular pedicle from the subclavian and brachiocephalic vessels, which were cauterized and divided. Through the left thoracoscopic window to access the right side, the mass of the lesion was identified and outlined in the mediastinal space. And the blood vessels supplying the lesions were cauterized and divided.
While preserving the right phrenic nerve, the surgeons removed the entire mass of lesions, weighing 600 gm, with no residues.
To assess the outcome post-operatively, X-rays were taken, which revealed no mediastinal mass, indicating the success of the thoracic procedure in treating giant thymolipoma. The child was discharged after 4 days of operation.
Surgical excision, with video-assisted thoracoscopic surgery (VATS) being the primary treatment for thymolipoma, the application of thoracoscopic techniques in the management of this condition in children is rare, with fewer than five reported cases in the literature.
The successful outcome of this case opens new avenues for the application of thoracoscopic techniques in the management of similar conditions, offering hope to patients and families facing challenging medical diagnoses.
