Anterior mediastinalmass with total occlusion of the superior vena cava and distal tracheal compression

The case A 28-year-old female, with a medical history significant for mitral valve prolapse, has developed progressively worsening cough and orthopnea of 3 months' duration. A chest radiograph and computed tomograph (CT) revealed the presence of a large anterior mediastinal mass measuring 12 × 10 cm, with significant distal tracheal mass effect, but without occlusion. Chest CT also revealed dilated collateral venous involvement and a superior vena cava totally encased and occluded by the mass, which was suspicious for lymphoma. Efforts to diagnose the mass via transbronchial biopsy and supraclavicular lymph node sampling were nondiagnostic, so the patient was referred to a thoracic surgeon for mediastinoscopy and biopsy. In the days leading up to her procedure, her symptoms worsened, and she required admission for further evaluation. Her chest radiograph featured a large right pleural effusion, and transthoracic echocardiogram revealed the presence of right ventricular compression, a depressed left ventricular ejection fraction of 35% with moderate diastolic dysfunction, and a large circumferential pericardial effusion. In the hours leading up to the scheduled operation, her oxygen requirement increased, and she required upright positioning with a nonrebreather mask to maintain adequate oxygenation. Patient care Residents must be able to provide patient care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health. Communicate effectively and demonstrate caring and respectful behaviors when interacting with patients and their families.