Epidemiology of childhood malignant mediastinal masses and clinical factors associated with intensive care unit admission: A Singapore experience.

AIM: Majority of mediastinal masses in children are malignant. These masses are complex to manage as they have a risk of compression to surrounding structures. Many of these children have to be managed in the intensive care unit (ICU). Hence we sought to evaluate the local epidemiology of malignant mediastinal masses in children and their clinical presentation, and identified factors associated with ICU admission so that at-risk patients may be identified early.

METHODS

This study is a retrospective review of institutional case records of 56 children below 18 years of age from 2000 to 2015 with a malignant mediastinal mass. We collected data on their presenting symptoms, clinical signs, radiological investigations, treatment and correlated these factors with admission to our ICU.

RESULTS

Lymphoma was most common diagnosis, comprising 37 children (66.0%). There were 6 patients with neuroblastoma (10.7%), 3 patients with germ-cell tumour (5.4%) and 10 patients with T-cell acute lymphoblastic leukaemia (17.9%). Overall, 21 patients (37.5%) had to be admitted to the ICU. Almost all patients (98.2%) were symptomatic on presentation, of which lymphadenopathy was the most common (69.6%). Factors that are significantly associated with ICU admission are stridor, pericardial effusion and need for pleural drainage.

CONCLUSIONS

Malignant mediastinal masses in children in our institution range from leukaemias and lymphomas to germ cell tumours and neuroblastomas, of which almost all are symptomatic. These children have a risk of cardiorespiratory collapse and many of them require intensive care. We identified factors that are associated with ICU admission, with the aim of early intervention of at-risk cases.