Pulmonary edema during cesarean delivery in a patient with a mediastinal mass.

PURPOSE: To report the management of a Cesarean delivery complicated by postpartum pulmonary edema in a parturient with a large mediastinal mass.

CLINICAL FINDINGS: A patient with an anterior mediastinal mass presented to the labour and delivery floor at 37 weeks of gestation with cough, severe dyspnea, and chest pain. Radiological investigations revealed that the mass occupied mainly the right side of the thorax and produced compression of the mediastinal structures. The patient underwent an elective Cesarean delivery under epidural anesthesia; however, immediately following the placental delivery, she developed unilateral pulmonary edema. She was managed successfully with diuretics, and her subsequent course in the hospital was uneventful. The biopsy of the mass revealed a lymphoma, which was treated eventually by chemotherapy. Both the mother and her baby are doing well after two years of follow-up.

CONCLUSION

A multidisciplinary approach should be considered in the management of a pregnant patient with symptomatic anterior mediastinal mass. Practitioners should be aware of the possibility of unilateral pulmonary edema in patients with an anterior mediastinal mass compressing pulmonary veins. Such patients should be treated promptly with diuretics to prevent further adverse outcomes.