Ruptured infected mediastinal teratoma complicated with pericarditis and cardiac tamponade: A case report

• Published in: Pediatric hematology oncology journal 2024-09, Vol.9 (3), p.133-137
• Main Authors: Alalawyat, Hanaa, Tawfeeq, Mansour, Omara, Abdelwahab, Chamdine, Omar, Hegazy, Marwan
• Format: Article
• Language: English
• Subjects: Cardiac tamponade; Mature teratoma; Pericardial effusion
• ISSN: 2468-1245; 2468-1245
• DOI: 10.1016/j.phoj.2024.04.003

While most mediastinal teratomas remain asymptomatic, on rare instances it may rupture into the pericardium, leading to pericardial effusion and cardiac tamponade, which is associated with high mortality rates. A 12-year-old male presented with syncope and tachycardia, which prompted further investigation. Chest radiography revealed a lobulated and homogeneous mass in the anterior mediastinum. Subsequent thoracic computed tomography (CT) scan revealed a complex anterior mediastinal mass exhibiting cystic and solid components, with calcification, fatty elements, and a significant pericardial effusion. Pericardiocentesis, performed to alleviate the tamponade, evacuated a large volume of purulent fluid. A total resection of the mediastinal mass was performed using a transthoracic approach with a cardiac window into the pleural cavity. The resected mass was a ruptured multicystic structure filled with pus and composed of muscle and tendon tissues. Microscopic examination confirmed the diagnosis of a mature teratoma. Following the procedure, the patient experienced a complete recovery without any complications. The rupture of an infected mediastinal mature teratoma into the pericardium is an uncommon occurrence, yet it poses a significant threat with a heightened risk of mortality. Timely surgical intervention is imperative to minimize the complications associated with rupture.